Silent Fear

A Medical Mystery

by Barbara Ebel

A Dr. Danny Tilson Novel

*****

 

This is a stand-alone novel, even though it is

Book Two in the Dr. Danny Tilson series.

Book One is Operation Neurosurgeon.

 

*****

 

Silent Fear: a Medical Mystery

Copyright © 2014 by Barbara Ebel, M.D.

This book is also available in a print edition.

License Notes

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means – whether auditory, graphic, mechanical, or electronic – without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

Ebook ISBN: 978-0-9911589-1-1

Paperback ISBN: 978-0-9911589-0-4

This book is a work of fiction. Names, characters, places and events are the product of the author’s imagination or are used fictitiously. Any resemblance to actual events, persons, or locations is coincidental.

However, this novel from the credible medical fiction writer is based on an organism that really exists.

 

In celebration of fine books

that aren’t discovered yet.

.

*****

Silent Fear: a Medical Mystery

 

 

Chapter 1

 

Danny rolled over as the first rays of daybreak slid through the blinds. His dog, Dakota, stood next to the bed, his amber eyes inches away. The retriever’s devotion inspired Danny to smile as Dakota hoisted his front end onto the bed and nuzzled into his owner with a great push.

Danny rustled Dakota’s sorrel head and coat, shoved him aside, and got up. It was nice having a weekend off like a few weeks ago when he’d been suspended from his group. He dressed quickly and passed the coffee pot his sister Mary had left warming in the kitchen. This morning he’d attend to the family garden and trees like his parents did when they were still alive. He stepped into the garage, grabbed a saw, and walked back through the kitchen and French doors to the expansive yard. Dakota ran ahead chasing a squirrel. After it scampered up a tree, Dakota used the trunk as a fire hydrant marking the maple as his own.

After one hour of pruning lower limbs off several stately trees and listening to the warbling of the birds, Danny had one area remaining. He hoisted the saw and with multiple attempts, cut a chest-high limb off the nearest evergreen. He threw it to the side, stepped to the right, and again raised the saw. He wished he’d had that cup of coffee as he sliced through the limb. The mid-morning late July sun warmed the temperature and even Dakota sprawled in the shade nearby, spent after his backyard excursions. As the remaining bark broke from the trunk, the blade hit Danny’s left hand, too slow to sweep out of the way.

The pain and the suddenness caught him by surprise. Damn, he thought as he dropped the tool and blood began dripping onto the dirt. Dakota sprang next to him thrusting his snout into Danny’s hand all the way back to the house where Danny sat on a deck step and took a careful look. The injury appeared jagged but clean. Dakota’s tongue took a generous swipe of his palm.

The door opened and his sister, Mary, came out with his best friend, Casey, behind her. “We found the perfect wedding bands,” she said. “The jewelry store is engraving our inscriptions.”

Danny glanced up at her, letting Dakota have more liberal access to sopping up the blood saturating his hand.

“Danny!” Mary crouched down. “What happened?”

“I was trimming trees. I handle a scalpel much better than a saw.”

Mary gave Danny a hard stare as he continued giving Dakota free rein. “Would you quit letting him lick you like that. Isn’t that cut too deep?” She looked up at Casey. “You’re the paramedic. Would you talk some sense into him?”

“I shouldn’t meddle with medical suggestions” Casey said, shrugging his shoulders. “I’ve given him enough advice the last few months. He owes me a punch and after all, he outranks me and he’ll start in with his ‘you’re only an ambulance driver’ routine.”

Mary looked up at her fiancé and grinned.

“All right,” Casey relented. “Does it need stitches?”

“Not on my day off from being near a hospital,” Danny exclaimed. “Do you have any Steri-Strips in your supplies?”

“I’ll go check but you wash it first.”

Mary got up and Casey linked his arms around her waist for an affectionate squeeze. “Casey Hamilton, you’re incorrigible.” She lowered her voice and added, “Fix my brother’s wound and I’ll sidetrack Dakota.”

----------

On Monday morning, Danny had only one elective surgical case scheduled. He stopped at the OR front desk after changing into scrubs and studied the caseload board hanging on the wall. He noticed that Harold Jackowitz, one of his partners in The Neurosurgical Group of Middle Tennessee, still had a case going from the middle of the night, with another emergency to follow.

“Dr. Tilson, you’re just the doc I want to talk to.” The head nurse leaned over the counter. “Dr. Jackowitz is finishing up his night call. Can you pick up his next emergency we didn’t get to and follow that case with your own?”

“Sure thing,” Danny said. “I’ll go tell Harold.”

The nurse succumbed to a smile behind Danny’s back as he left because he’d straightened out his work behavior. He had been more than infatuated with Rachel, one of the scrub techs who had worked there only a few months.

Danny hurried down the hall after putting on an OR hat. He grabbed a mask, slapped it over his face, and swung into OR 2. Staff counted sponges and accounted for instruments in anticipation of finishing their case, but they looked like they’d been dodging thunderstorms all night.

“Am I glad to see you,” Harold said after looking across at Danny. “There’s a fourteen year old in the ER with an intracranial bleed due to a boating accident. Can you take care of him for me before draining your own patient’s residual abscess? I sure would appreciate getting home to bed.”

“Sure thing,” Danny said. “Tell me what else you know about the patient.”

“I haven’t seen him because I’ve been wrapped up here. We put the ER doc’s call on the intercom. He said this kid got hurt on Saturday but the parents brought him in around midnight after he complained of a headache and he started to get lethargic. C.T. scan is positive for an acute subdural hematoma.”

Harold took a step back and let the anesthesiologist start moving the table back to him. He wiggled his shoulders to loosen up.

“Okay,” Danny said. “Go get some sleep as soon as you can. You had a bad call.”

“I know, this is your kind of luck, not mine.” He snapped off a glove and picked up his pager. “Speaking of luck, how’s your situation? I don’t ask because I never know if I should bring it up.”

Danny hesitated at the loaded question. “Thanks for asking. I’m back on track. Even my personal life has calmed down, but that’s only because Rachel got what she wanted and I’m taking a wait-and-see approach as far as our baby. More importantly, I’m glad I still see my ex-wife, Sara, because of our girls.”

“You must be the only divorced guy I know who wants to see an ex.”

Danny nodded. Harold had a point.

“I’m glad to know life has turned around for you.”

Danny took a step towards the door. “Thanks, I appreciate that. Okay, you’ve got orders to write. I’m off to see this kid and whoever’s with him. What’s his name and what’s his Glasgow Coma Scale?”

“It’s Michael Johnson. His parents are with him and he’s got a decent score of thirteen.”

----------

As Danny walked over to the pre-op area he thought about the summer months. The last four weeks of getting up early and going back to work had been a welcome relief. Before that, suspension from his group and sleeping late had made Danny feel useless. The best tranquilizer for his body and mind, he had learned, rested with the steady purpose of productivity. He had yearned for the tempo of the O.R., the urgency of the neurosurgical trauma cases, and the pride he felt using his astute diagnostic and surgical skills. Except, of course, for the mistake he had made with a Multiple Sclerosis diagnosis.

Because of that case, Danny hoped to never use the services of malpractice attorneys again. As it was, he kept lawyer Mark Cunningham gainfully employed with his post-divorce matters with Sara and the separate Rachel Hendersen debacle. He’d had an extra-marital affair with Rachel which resulted in a baby he hadn’t known about. Although he resembled many other men paying an ex-wife child support and alimony, he considered himself more rare to be paying a second woman he hadn’t married, especially since he’d been deceived. Sometimes he was tempted to put ‘stupidity’ on forms where it asked for a middle name.

Danny thought back to the issue at hand as he entered the holding area where a nurse greeted him and laid a patient’s binder in his hands.

“Good morning Tracy. Thank you,” he said. When he finished reading the E.R. notes, Tracy handed him the C.T. envelope. A laugh tumbled out of his mouth at her promptness and she smiled. Even though she’d had a poor plastic surgery repair of a cleft lip, her smile glowed. He snapped the film onto the view box behind them and evaluated the hematoma showing a concavity towards the brain.

“Has anesthesia seen him?” Danny asked.

“Yes, Dr. Talbot came by and did an evaluation.”

She motioned to the first cubicle to let him know where the patient waited. Danny peeled open the curtain as Tracy followed. Michael Johnson filled the length of the stretcher, which made him a good six-foot-two like Danny. They don’t grow fourteen year olds like they used to, Danny thought.

“This must be Michael. Are you both his parents?”

A mid-forties couple, sitting on opposite sides of the stretcher, nodded.

“I’m Dr. Tilson, the neurosurgeon.”

“Nice to meet you, doctor,” the man said. “We’re John and Stella Johnson.”

“Nice to meet you also. I’m sure this isn’t where you’d like to be. Michael, how are you doing? Could be better, right?”

“Mmm,” slurred the teen. “Did you come to take more blood?” Michael closed his eyes again.

“Doctor, he’s a little confused.” The woman sat forward and toyed with the leather handle of her purse.

“Please, tell me what happened,” Danny asked.

The couple looked at each other. “You go ahead,” John said to his wife.

“Saturday we went boating on Center Hill Lake. We’ve got a small pontoon boat. We were close to an island where Michael and his friend and younger brother were swimming. Michael also kept climbing up and jumping off the adjacent rocky cliff. It’s a good twenty foot plunge into the lake. Funny thing is, we get worried when he does that. We tell him not to do it, but it’s to deaf ears. But that wasn’t the problem.” Stella stopped to collect her thoughts. She dipped her hand into her purse and pulled out a tissue.

“Doctor,” John said, “after the kids climbed back on the boat, some idiot came flying by on his motorboat, which tossed our boat around from his waves. I always tell my son reckless boaters are mayhem. Anyway, Michael was the only one standing and spilled forward smashing his head into the boat’s console.”

“Did he pass out?” Danny asked.

“No, but we thought he would.” John looked over at his wife, who now held her son’s hand on the stretcher.

“The E.R. doc must have explained what’s going on,” Danny said. “The hematoma Michael suffered in his brain must be managed by surgical evacuation otherwise his prognosis is going to deteriorate. The blood in there will continue to cause pressure on his brain or increase his intracranial pressure. We can’t let that happen, okay?”

“Dr. Tilson,” Stella said, “Do you have children of your own?”

“I do.”

She looked at her son, deeper into a sleep, and lowered her voice. “Then you may understand the bond and how scary it would be to have a child near death’s door.”

Danny briefly closed his eyes. “I’ll take care of your son, Mr. and Mrs. Johnson.”

After Danny finished examining Michael, he left. Tracy put another cotton blanket over the teen while his parents watched. Stella followed Tracy as she went out. “I hope Dr. Tilson does a good job,” she said. “I hope he felt our concern. We’re worried we may lose him.”

With a soulful stare, Tracy looked into her eyes. “Dr. Tilson understands your worry more than you know, Mrs. Johnson. He lost a daughter a few years older than your son.”

----------

The buzz of the Monday morning OR chit-chit subdued while the nurse and Lucy Talbot, the anesthesiologist, explained a few things to Michael. Danny came in early to the OR room to evaluate Michael’s last minute progression of symptoms before they gave him sedation and put him to sleep. Finally, Lucy gave a dose of Pentothal and Vecuronium and opened Michael’s mouth. “Sure is juicy in here,” she said. She grabbed the suction tip under the headrest and suctioned out his copious secretions. After she inserted the endotracheal tube and confirmed placement, she nodded with approval.

Danny grinned under his mask at all the slobber. The only oral secretions he ever dealt with were Dakota’s, and his were enough.

The rail-thin anesthesiologist pulled out the tube she’d just placed and put it on the patient’s chest. “He’s quite mature for his age, isn’t he? I need a bigger one.” She gave Michael some more puffs of oxygen from the mask she’d placed over his face. Dotty, the OR nurse held up another package and Lucy Talbot shook her head. “An eight should do.”

She slid the next tube into the trachea, confirmed correct placement, and slid off her blue gloves to put the patient on the ventilator with inhalational anesthetic. Danny and Dotty both handed her the wet array of packaging, contents, and laryngoscope. “What a sloppy mess,” Dotty said.

After preparing his initial part, Danny went to the sink outside and removed the Steri-Stips from the palm of his left hand to scrub. Healing had begun on Sunday’s cut, but it hadn’t yet totally epithelialized. He went back in and after donning the rest of his surgical attire, sat at the head of the table where Michael’s head was ready. They put drapes and Danny asked James, the scrub tech, for his second most important instrument – the drill.

Dotty put the radio on. “Is it okay if I keep my genre of choice, y’all?”

An iconic female country singer’s voice filtered the room. “The only thing more theatrical in these OR’s besides the conversations,” Danny said, “is the music. How can we argue listening to her in the Music City?”

“She’s playing at Opryland next weekend,” Lucy said. The little anesthesiologist popped right up from her catch-up charting. “Anyone have tickets?”

“I wish,” Dotty said.

James stood poised with the suction tip as Danny drew nearer to finishing the bur hole in Michael’s skull. The drill bit stopped, the bone dust stopped, and the evacuating noise of the hematoma began.

“Seeing her is on my bucket list,” Danny said a minute later. “She’s got my respect. Not only does she have a distinctive voice and talent, but she’s a heck of a business woman. I think she keeps plastic surgeons gainfully employed, too.” His laugh, which rolled over extra, infected them all, causing copious chuckles.

“I admire her philanthropic nature,” James said. “She does programs for disabled kids and has a free kid’s summer camp in eastern Tennessee. Kids are picked by one of her committees and they go in two week increments.”

“I think the program’s called ‘It’s the Best Summer After All,” Lucy said, “and unlike some entertainers, she stays out of trouble.”

Except for the music, the room got quiet until the OR doors swung open and the head nurse came walking in. She stopped behind Danny’s shoulder. “Dr. Tilson, we’ve brought down you’re first scheduled patient to the holding area. They wanted me to tell you he has a small fever.” She looked at Dotty and James. “You two are staying in this room to do it. It’s the brain abscess drainage.”

“Okay,” Danny said, “thanks.”

“Dr. Tilson, I’m doing the next case as well,” Dr. Talbot said.

----------

Danny looked over his patient’s chart, the case they had delayed, while he sipped coffee. Troy Neal was a sixty-five year old farmer who had been hand reaping and managed to fall on his nearby sickle. The resulting skull fracture had introduced the infection resulting in his brain abscess. Danny told him it could have been far worse. Despite appropriate antibiotics, the remaining pus needed surgical drainage and this appeared to be the last surgery he’d require.

After leaving a small amount of his coffee on the counter and hearing Tracy’s voice inside Mr. Neal’s cubicle, Danny stepped inside. He stretched out his hand for a thorough handshake from the wiry bald man. He’d been a true gray before they’d shaved off his remaining hair.

“Don’t want to meet you like this anymore, Doc, and I don’t want to be carrying around these Staph and Strep guys in my head anymore, neither.”

Danny rolled out a chuckle. “I’m sorry to laugh, Mr. Neal. You get an A in the crash course you’ve taken on medical jargon. Just don’t use yourself as the patient next time.”

“I didn’t plan on no metal in my head. You have any ancestors with farming blood?”

“No. My Dad and Mom were primarily in the restaurant business. Right here in Nashville. My Mom’s parents ran nurseries, which is where she got her green thumb.”

“Well, at least they knew about growing things. Thing is, my Daddy told me about the bad bugs in soil. I probably knew more about them there things before you went to the fancy institutes to learn it.” His sinewy hand scratched his sparse eyebrow. “And modern society and all this technology wouldn’t be anywhere if it weren’t for farmers. We put the food of vitamins and minerals and protein on their plates.”

Danny nodded his head in agreement. “And I, for one, thank you for it.”

A serious-looking orderly poked his head in. “I’m here to wheel Mr. Neal back to the O.R.” Tracy nodded and handed Troy a head bonnet from a box on the shelf.

“You’ve run a low grade temp on and off again the last day,” Danny said. “We’ll keep an eye on you post-op today and tomorrow but you should be out of here soon.”

At the counter, Danny pitched his residual cold coffee as Tracy handed the chart to the orderly. She caught Danny before he stepped away. “Dr. Tilson, how did Michael Johnson do?”

“No problems. He’s sleeping off anesthesia in the recovery room. It’s amazing the resilience of a young brain after trauma. He should bounce back just fine.”

 

 

Chapter 2

 

 

If Rachel were to draw up a list of her finest attributes other than her decadent figure, adaptability to any kind of situation would top the list. Despite even her best planning, circumstances had changed beyond her control, requiring an adjustment in direction. The trick to survival was to gain comforts with the least self-expenditure and to use your highest cards skillfully. Love played a slight role, too, only since she’d had a baby and developed a fondness for her own infant, the strength of which she hadn’t banked on.

Rachel liked to think of Julia as her own infant, especially after Dr. Danny Tilson paid her little child support those months he had been placed on a leave of absence. Thank goodness her attorney, Phil Beckett, had continual correspondence with Danny’s attorney and found out he was working again full time. Phil had litigated to increase the support ante to Rachel as the good doctor was back to a six-figure annual income. He even got her a retroactive raise to the first day Danny went back. Rachel could have kissed his nuts.

But it wasn’t Phil’s nuts on Rachel’s mind these days.

His name was Leo. Rachel had plenty of time off when arriving in Knoxville, having her baby, and getting used to motherhood, but she felt the money crunch. She hadn’t been able to keep the money she’d hoisted from Danny’s Einstein book either and she didn’t even have the merchandise to resell anymore.

Rachel took another surgical tech job, one ten-hour shift, for one day a week. It turned out that’s all she needed because she made headway with a pharmacist she met the second week on the job. Her milk-engorged breasts made her more voluptuous than ever. Leo, one of the hospital’s pharmacists, practically spilled his pills when he saw the gorgeous aqua-eyed OR tech walk in for a prescription.

Leo lived a modified single guy’s life. Already in his late thirties, he didn’t go through women as fast as he used to. Now he opted for only one woman at a time. Occasionally he would let more desirous ones live with him. Although his pad consisted of only a two bedroom, one story house with a finished basement on a half-acre, he’d gone through great pains to create the most lavish chick-magnet setting in the area he lived in. His front corridor had a ten-point buck’s head mounted on the wall, and without fail, he’d point to his expensive rifle display and brag about how that weapon was used to kill the sucker. Actually, he’d never gone hunting in his life, except for women.

----------

Friday afternoon drew to a close. Rachel had spent the entire day pampering herself and enjoying mother-baby time on the teakwood deck. Shacking up with Leo for the last two weeks had been a godsend … it suited all her purposes. She had no rent or major expenses, she made a bit from her job and banked most of Danny’s child support, and the surroundings for her and Julia proved opulent. Leo worked forty hours during the week and she sweated her shift on Saturdays, so she didn’t have to contend with him that often. He had a maid occasionally come in during the day as well.

After coming inside, Rachel placed her lemonade on a marble coaster. She lightly bounced Julia on her lap as she looked out the glass wall to the deck. She’d been careful not to be out too long in the heat and expose their fair skin to the sun. Looks and body came first, not only for herself, but for baby Julia as well. Julia gave a little squeal from the motion and waved her hands up and down.

Rachel heard the thud of a car door, the front door opened, and Leo strutted in. His medium height matched Rachel’s and he had a chiseled look with tight sharp facial features. He wore sweat above his lip, constant summer baggage he despised.

“You beat looking at prescription bottles,” he said, immediately spotting Rachel. His deep voice filled the high-ceilinged room.

Rachel put Julia on the floor. The baby sat up then tried haphazardly to perfect her crawl while Rachel continued to swivel her chair around and crossed her legs.

“I’m glad. You’d make a nice postcard, too. All’s well at work?” She snickered to herself regarding her last comment because she doubted filling prescriptions was an exciting job. It was Danny Tilson, the father of her baby, who did something far more challenging.

“Everything’s good as long as I fulfill the proper drugs and dosages into little containers and bags. But it’s not always as easy as it seems. I sent back a manufacturer’s entire lot of a diuretic today as the whole lot smelled counterfeit.” He walked closer to Rachel and slid his hand under her chin.

“Smelled counterfeit?” she inquired.

“Metaphorically speaking, that is.”

Rachel got up and their lips pressed. “It’s going to be a hell of a Friday night, isn’t it?” she asked, toying at the top button of his shirt.

“Sure is, especially after I take you out for a bottle of wine and quick bite.” He looked over at Julia who seemed inquisitive alongside a book rack on the floor. “Baby Julia won’t miss us. We’ll leave her here this time.”

“Leo,” she crooned. She thought quickly. She’d never left her baby alone before. “I don’t have a sitter, that won’t work.”

He nestled into her hair and pulled her closer. “Baby, your velvet voice is intoxicating.” He nudged her back and looked serious. “We’ll wait until she’s sleeping and slip out only for an hour.”

----------

The nightly ritual with Julia had gotten easier as Rachel had stopped breast feeding. She fed, diapered, and changed her, then placed her in the crib in the second bedroom making sure she pressed Julia’s sleeptime to later than normal. Julia gurgled and cooed but took only a few minutes to fall asleep. Rachel closed the door half-way, went to their bedroom and slipped on a violet dress complimented by open, short heels.

“Come on, big guy,” Rachel said, placing her hand on Leo’s shoulder at the bar in the great room.

Leo’s favorite local place where he had taken Rachel for their first date was Maxine’s. On that date, he recalled, he hadn’t even used a date-rape drug because she seemed naturally hot and easy to score.

Maxine’s bar took in more business than the number of table seats for patrons that it needed to qualify for a liquor license. There were always jumbo peanuts in jars at the bar and lots of ash trays. It was still a friendly place for tobacco users, for which Leo qualified. He’d cut back from chain smoking by necessity because of the abstinence he had to endure while working.

“Come on, baby,” Leo said, grabbing Rachel’s hand and steering her to the bar.

“Let’s sit at a table, Leo.”

“It’ll be quicker up here.” He wrapped his arm around her shoulders to keep her moving forward. “The sooner we get a drink and some of Maxine’s ribs, the faster we get back, you check on Julia, and we get it on,” he whispered.

Rachel narrowed her eyes with approval.

“What’ll it be, Leo?” asked one of the usual college bartenders.

“We’ll take two big plates of ribs, slaw, fries and two beers to start with.” Leo lit a cigarette and took a big drag.

Rachel gestured with her hand. “Skip the beer for me, Leo, I’ve got to work tomorrow. I’m not going to drink a thing tonight, especially if Julia wakes up during the night.”

He blew a bit of smoke from the side of his mouth where the air borne circles gravitated towards his early thinning hair. His hair was slicked over by gel which, like lubricant, was one of his favorite tools.

“Don’t forget, Leo, you’ve got Julia tomorrow. I really appreciate it. You’re not a bad stand in father.”

“Don’t call me that Rachel. I’m not too happy when she cries or when she’s not sleeping.”

“Leo!”

“Just kidding.” He looked charmingly into her striking eyes and then followed down to her cleavage. He paused to inhale while his beer arrived.

“Working one day,” she said, “does a lot to keep my resume viable for the future and my options open. And it’s really no sweat on either of us. You know I would have gotten a sitter for tomorrow if you had asked me to.”

Leo turned slowly to her. “Depends on what she would have looked like.”

“She could have been pretty, but a thousand babysitters couldn’t handle you like I do. And there’s no competition when it comes to looks or brains.”

Leo popped peanuts into his mouth while the platter of ribs and sides were set before them. “Thanks,” Leo said. He looked at Rachel. “You’re right about that. It’s what made me step up the quality of my women in the last few years. There are gorgeous women everywhere. It becomes more challenging when there are more synapses in their brains.”

“Don’t go talking like a neurosurgeon.”

“Why? Do neurosurgeons have something to do with your past?”

Rachel looked away for a second.

“We haven’t known each other that long,” he said, “and I haven’t intimidated you with questions … yet. Don’t tell me that guy you’re getting monthly checks from is a high-roller? Not some dumb-ass pharmacist?”

Rachel kept her dissatisfaction with his comments from showing. “Leo, you’re far from dumb. You’ve done well for yourself.”

He picked up a saucy rib and chewed off a chunk of meat. He wiped his fingers on a napkin and turned to her.

“You didn’t answer my question.”

“Yeah, he’s a neurosurgeon, a thing of the past.”

“Not for your daughter. Guess you know how to pick ‘em, babe.”

----------

Rachel breathed a sigh of relief when they got back. Julia was sleeping soundly, which made her eyelids flutter like a butterfly as if in a big dream. Rachel placed her hand on Julia’s head and stroked her fine light hair. The baby stirred but contentedly settled again. “Sleep through the night, baby Julia.”

In the bedroom, Rachel dropped off her dress, removed her underwear and shoes, and put on a long tee-shirt, as sexy a look for her as a negligee. Leo’s bedroom and bath were her favorite places in the whole house. For a guy, he had taste with a matching bedspread and shams, and the mattress was like sleeping on clouds. Each wall had a large painting; she believed he had artistic knowledge because they varied from far-out modern to photographic realism. When he wasn’t around, she would bask in his luxury whirlpool tub and then pamper her skin with organic moisturizer.

She laid out a few things for the morning. She’d been slotted to tech for the general surgery room, whether elective or emergency and there wouldn’t be any surprises as far as staying over after her shift. Leaving Julia with Leo had worked out fine, but his minding her routinely on Saturdays would soon change. The lawyers were arranging some weekend visitation with Danny, starting next weekend if everyone agreed.

After turning out the larger overhead light, Rachel switched on a table lamp, a figurine of a man and woman wrapped around each other. She slid under the covers and closed her eyes for a minute. Leo always spent time on his computer at night, but she knew she’d see him soon based on his remarks at Maxine’s. She didn’t mind his sexual appetite, especially since she was a bit of a tramp herself.

Through the doorway, the lights went off from the great room, and Leo’s dim figure appeared in the bedroom. Rachel turned on her side as he walked hurriedly into the bathroom, unbuttoning his shirt along the way. He came out naked but she lost him when he went around the bed and climbed in under the sheet behind her. His arms circled her. His biceps were hidden gems under his shirts; although they weren’t huge, they were hard like rocks.

Rachel went to turn but Leo tightened his arms. He playfully bit her neck. “Like a tigress waiting to be tamed,” he said. “You can let me do all the work tonight.”

Rachel went to turn again as his arms slipped down to her hips. “Whoever said it’s work, Leo? It’s all pleasure.”

His breathing increased next to her ear while his hardness stiffened between her cheeks. “That’s perfect then.” He pulled her closer.

“But Leo, I don’t like it that way.” Rachel gathered a bit of momentum to move forward.

“You haven’t had it done to you by an expert, that’s all.” Leo’s grip tightened on her hips. He reined her in as close as he needed and then he did the rest.

----------

Rachel jolted awake when her watch alarm sounded. Without disturbing Leo, she got ready and marched gingerly to the kitchen for a bottle. Her bottom didn’t feel too comfortable. Damn Leo, she thought. That was nervy of him last night. She fed and changed Julia and placed her back in the crib. Rachel toyed with her small hand while Julia’s eyes twinkled back. “See you later,” Rachel said. When Rachel left, Julia looked like a content kitten.

Three hours later, Leo opened his eyes to sunshine and quiet. He silently thanked the stupid stars for weekends. He slipped into slippers and jockey shorts and went to the kitchen, microwaved some water, and spooned instant coffee into the cup. He took a few steps to the other bedroom where Julia babbled in her crib, but he made sure he wasn’t seen. They’d get along fine as long as she didn’t need anything from him for awhile.

Leo turned on his big flat-screen TV, grabbed his coffee, cigarettes, and yesterday’s newspaper, and sat in his recliner, immersed for another two hours. He finally got up, dressed, and picked up Julia and put her in the high chair. After picking out a pureed baby fruit jar from Rachel’s few things in the closet, he fed her like Rachel had instructed. He considered it his good deed for the day because he’d rather be out looking for a new car. He placed her on the rug with a bottle while he went to fix a hinge on a cabinet, and go through mail and paperwork.

Leo finally opened a new pack of cigarettes but didn’t light up when he spied Julia on the floor. He picked her up and carried her to the bedroom where he begrudgingly changed her diaper and left her there for a nap. Back at his desk, he went over his credit card statement. The charges flowed over to the second page but nothing appeared out of the ordinary. He decided to calculate the last six month’s expenses to figure out if he could afford a new sixty-thousand dollar car. Better to lease, buy-outright, or find a low interest loan?

He lit up the cigarette he should have smoked thirty minutes ago. Outside, a wind kicked-up and the leaf-heavy trees swayed. He leaned backwards in his chair, dragged on his smoke, and appreciated his built-in desk alcove facing the yard. With the same long glass windows as most of the back of the house, the desk area had been his idea. He had chosen the perfect contractor to build him his little work station without interfering with the central beauty of the big room.

Inside the guest bedroom, Julia started to cry. It abruptly broke into Leo’s silence. He took another drag and peered down onto his pad of paper where he tried to make the numbers stretch to his advantage. Within a few more minutes, he let out a sigh. Julia’s crying rant had gotten worse.

When Leo pushed back his chair, he mashed out his cigarette with an expletive. He hurried to the bedroom. “You have to shut up,” he said, looming over the crib. Julia’s face got redder as she cried. Leo picked her up, held her on his chest for a few seconds, but it made no difference. He placed her back in the crib. Her crying pitched louder. He walked out faster than he had come in and sat back down in his chair. Now, however, the noise coming from Julia’s room was screaming, not crying.

“Fuck this,” Leo said and ran to the bedroom. He placed both his hands along the sides of Julia’s chest and dragged both thumbs over the bottom of her breast plate. An anatomic thought came to him, despite the fact that he wasn’t thinking so well over a damned baby’s screaming. He pushed down with his thumbs. He felt a snap. Julia pitched a wail that sounded like a pain-stricken animal’s plea.

Back at the desk, Leo started another smoke. Now his silence would never return. The crying was louder and sounded more terrifying. Give it something else to cry about, he thought, to make it go to sleep. He pulled on his cigarette and exhaled a cloud. Smoking should be one of life’s pleasures. He studied the red glow at the end of his cigarette.

Leo tried an old trick and counted to ten. Why should he be counting to ten in his own house anyway? At ten, he jolted out of his chair and stormed to the bedroom. Not without his cigarette.

Julia’s face was beat-red. Her face looked crumpled and aged. Leo grabbed her right arm after putting the railing down. He jerked it up, took a second to choose the area, and lightly pressed the tip of his cigarette. For a second, Julia’s face lapsed into horrific surprise, and then an even louder scream pierced his eardrums. Leo felt rage. He whipped off her diaper, grabbed her legs up with his left hand, and ground out the cigarette in her buttocks.

 

 

Chapter 3

 

After Danny’s two morning cases, he arrived at the office to an overflow of patients. Some days the predictability of a schedule proved useless. One of his patients even requested that he see his wife because she came along and had never seen a doctor about her migraine headaches. They were convinced she had a tumor and thought they could fit in two appointments instead of one. It wasn’t convenient for his other patients who were killing time in the waiting room.

The afternoon zoomed by and Danny hadn’t eaten lunch. He tossed his stethoscope on the couch under his Norman Rockwell fishing print and grinned. The picture stood for more than a pretty print. It represented some flow of continuity to his life – it had stayed right in his undisrupted office during most of the last year’s turmoil. His stomach started to grumble as his nurse, Cheryl, came through the open door.

“Aren’t you going to eat what’s on your desk?” she asked.

Danny strutted over to a vegetable assortment with dip, a piece of cake, and a cup of coffee.

“Looks like left over party food,” Danny said.

“You missed our late morning birthday break for Dr. Garner.”

“I didn’t know Bruce grew older.”

“He tried to keep this one quiet but that’s impossible around here.” Cheryl took the files in Danny’s outbox and put a telephone message on his desk. “Mark Cunningham called,” she said. “He asked for you to call him at the office.”

Danny chewed a vegetable slice before answering. “I’ll get a hold of him right now.”

“However, I know you didn’t eat lunch, so why don’t you take a little break while x-rays are being done on your patient?”

“Thanks Cheryl. Appreciate the food.”

“I think it’ll be closing time soon for most staff. How about rescheduling a few appointments?”

“That’s fine, reschedule them for the first thing in the morning. I’ll let you know if I can get Harold to see my hospital patients while he’s making his own rounds.”

“I’ll try, Dr. Tilson.”

Danny called Harold as soon as he sat down. After giving Harold his patients’ names and information, Harold said, “No problem. I owe you.”

Next, Danny called his attorney. “Mark, it’s Danny, did you get things ironed out with Rachel’s attorney?”

“The paperwork from Phil Beckett confirmed the verbal agreement. When you want it, you’ve got two weekends a month for visitation with Julia.”

“Thanks Mark. I’ll call Rachel and set it up for this weekend.”

“Danny, what do you want to do about custody? I know you were going to give it some thought.”

Danny stared at the birthday cake, which made him think of his baby girl who would have years of birthdays without him. That is, if things stayed the way Rachel wanted them. On the other hand, his own life could have more stability if he kept litigation out of his hair. He had more legalities in his life the last year than prominent TV judges. Mark cut into his thoughts and helped him out.

“Even if we start proceedings, Danny, custody hearings, a trial, or even an agreement between two parties takes time. I’d advise you to go ahead in that direction. You can always back out later if you decide. Give it some thought and call me soon.”

“Okay Mark. We’ll leave it at that.” Danny hung up and took a sip of cold coffee. He grimaced and masked it with cake as Bruce came in. “Happy birthday,” Danny said. “Sorry I missed the celebration.”

Dr. Bruce Garner slid out the chair across from Danny. He needed the extra leg room. The founding partner of their group looked the same as he did for last year’s birthday. He was aging like a shiny dime.

“Celebrations suit the staff,” Bruce said. “It breaks up office monotony and gives them festivity. I’m celebrating this weekend with my wife and we’re going out of town. You’re in charge but I’ll have my cell. Harold is on call.”

Bruce lingered. The visit seemed to be Bruce’s way of giving him a vote of confidence. He felt more at ease with his senior partner than he had in a long time and believed Bruce considered him a better surgeon than Harold and Matthew.

“By the way,” Bruce added, “the business books are looking good. We have a slightly higher percentage of unpaid statements that billing is working on, yet income is up.” Bruce got up and tapped the desk with approval.

“We have excellent people here, Bruce.”

“There’s always room for improvement.” Bruce’s long stride had him out of Danny’s sight as soon as Danny got up and grabbed his stethoscope.

----------

One thing Rachel liked about a ten-hour week was the distance she maintained from operating room politics. The charge nurse left her alone, too, because she was “only a part-timer.” Again, she’d played her cards just right. The day passed effortlessly, preparing and assisting with instruments in three surgery cases from an elective appendectomy to a melanoma removal. She looked forward to seeing Julia when she got off, less so for Leo.

After Rachel drove home, slipped her key into the front door, and entered, she caught Leo coming up from the basement steps in work-out clothes and a film of sweat. Other than the TV volume being low, she didn’t hear Julia.

“Hey, babe,” Leo said. He walked straight over to her, wrapped his arms around her shoulders, and placed a kiss on her lips. “Hey, don’t look so glum. Bad day at the office?” He tilted his head and smiled.

“It could always be better.”

“I’ll cheer you up.” Leo ran his fingers through her hair. “If anyone gave you trouble today, tell me. They’ll have to answer to me. I could switch their medication when they come in with a script.” He laughed and leaned in again for a possible kiss. “I tell you what, I’ll give you a break tonight and diaper Julia all the way to bedtime.”

“That’s considerate of you, Leo.” She immediately regretted her tone. After all, there were good things about him. “Is she taking a nap?” Rachel managed a smile and kissed him back.

“That’s more like the Rachel I know,” Leo said letting her go. “I put Julia in her playpen when I went downstairs to the gym.”

“Thanks, I’m lucky to have such a contented baby. I’ll go see her.”

Rachel went into the bedroom where the playpen sat near the wall and adjacent crib. Colorful toys dotted the bottom. Julia was stomach down fast asleep. She still wore the body suit Rachel had dressed her in that morning. Leo must have done a good job with her. Julia was sleeping peacefully. However, Rachel knew it was best to wake her now so that she would sleep better throughout the night. She turned her over and picked her up.

When Julia snapped out of her sleep, her little face registered alarm. “What?” Rachel said inquisitively.

At the doorway, Leo had followed her. He stood against the frame like a sports clothes model, suited in a muscle shirt and gym shorts. The drawstrings dangled down the front of his lower abdomen and a lighted cigarette dangled at his lips. He exhaled into the bedroom.

Rachel focused on Julia, who immediately started squirming in her arms.

“I know you don’t like the baby around my smoking,” Leo said. “I won’t even come in. It’s kind of sexy seeing you two there.”

Rachel cuddled the baby and patted her back but Julia wiggled even more and began to cry. By bedtime, Rachel realized that despite her best attempts, Julia was having a bad evening. She was grateful that Leo did the last diapering and slipped her into her one-piece sleeper for the night.

----------

Sunday morning Rachel woke in a good mood, refreshed after an undisturbed night. Leo sat at the edge of the bed, turned and patted her hip. “Hey, babe,” he said. He rose and bounded to the bathroom. Rachel slipped into slipper socks and tiptoed into Julia’s room to spy on her playfulness, hoping to find her awake. She grabbed a diaper and approached the crib. Julia made baby gestures like swatting invisible bugs, but not as much as her usual animated self. She didn’t burst into excitement when Rachel came to the crib’s side.

“Good morning, Julia. How’s my pretty girl today?” Rachel put the side rail down, leaned in, and gave her a kiss and a little upper arm squeeze. Julia’s neutral, yet wary expression changed to discomfort. Rachel placed her hand over the baby’s forehead. Maybe she had a fever. Rachel shook her head, probably not. She still had so much to learn about babies.

Rachel unsnapped the bottom of Julia’s sleeper, took the one-piece pajamas off, and put a top over her head. She pulled the sticky tabs from the dirty diaper and pulled the diaper straight out. Julia let out a painful sound, puzzling Rachel even more. “I’ll pick you up in a minute. I just don’t know what’s gotten into you.” Rachel put the diaper aside and picked up Julia’s legs to slide in a clean one. She put the new one down and began moving it under but stopped in horror.

Rachel gasped. She stared at a red circular, painful-looking area on Julia’s bottom. More alarm gripped her. The lesion wasn’t there yesterday when she had left for work. She started to blurt out for Leo, but realized she needed to be cautious. This weekend with him had left her feeling uncomfortable with their relationship. She must approach talking to him with trepidation. She put the guard rail up and walked back into the bedroom. The bathroom door opened and Leo emerged. He pulled on a tee-shirt flung on his nightstand.

“Leo, do you know what happened to Julia? She’s got a sore on her bottom.”

For a moment, Leo’s bottom jaw tensed, and then he chose his words carefully. “Babe, I didn’t want to disturb you about it last night. It was an accident. I brought hot coffee in there while I changed her yesterday. A bit dribbled from the cup. I’m sorry. She forgave me, too.” He smiled and looked into Rachel’s eyes.

Rachel didn’t know what to think. She wanted more details but it appeared as if he’d finished his explanation. “Leo, this is really bad timing. She has visitation with her father next weekend.”

“Don’t worry, it’ll be gone by then.”

Rachel turned and went back to Julia. She applied some salve to the sore, finished dressing her, and gave her a cautious hug so as to not touch her padded buttocks.

----------

The next morning Harold mixed his own patient list with Danny’s. Most of their patients were on the same hospital floor which pleased Harold. This morning, his right knee bothered him walking along the corridors. Sometimes it acted up from the weather; sometimes from inactivity, and at other times it ached from too much activity. He originally insulted it by playing too much tennis during college. The more he played, the better he got, until one day he pulled a ligament.

The last two patients to see for Danny were Michael Johnson and Troy Neal. He knew about their surgeries from the day before, so he glanced in their charts for any new notes since then. Troy Neal and Michael Johnson both ran a fever, which wasn’t new for Troy Neal. After surgery, in any case, post-op fevers were common and Harold knew most of them usually resolved spontaneously. Other than that, no problems had developed over night.

With a slight falter in his walk, Harold entered Michael’s room.

“Good morning, Dr. Jackowitz,” the day shift nurse, Peggy said. “Michael is the first patient I’ve checked on since getting here.” She held a plastic spirometer in her hands alongside Michael’s bedside. “I’m trying to get your partner’s young patient to use this as vibrantly as he probably plays on a basketball court.”

“We’ll talk about that, then,” Harold said and introduced himself to Michael. “You were almost my patient so I’m glad to take care of you this morning for my partner.”

The youngster’s head was still wrapped and his eyes still glazed, as if anesthesia still hung on to him. “Oh,” he said. “Where are my Mom and Dad?”

“They’ll be in a little later,” Peggy said, putting down the spirometer.

Michael fumbled for the wash cloth, brought it to his mouth, and expelled saliva which kept accumulating unnecessarily.

“He’s a wet one, Dr. Jackowitz,” Peggy said.

“If those secretions are coming from your throat,” Harold said, looking closer at Michael, “it’s best to keep practicing deep breathing with this plastic bedside breathing machine.”

Michael blinked his eyes in acknowledgement. Harold leaned in with his stethoscope. “Take a good breath,” he said. Michael inhaled and slobbered more on his washcloth, Harold, and his stethoscope when he exhaled.

Harold wiped his hands on what he hoped was the clean part of the cloth from Michael and then handed it carefully to Peggy. She brought another one from a fresh linen pile.

“We’ll keep our eyes on your lungs,” Harold said. “They’re clear right now.” Harold examined the wrapping around his head; no blood stains, pus, or bulging. “Dr. Tilson will see you next time. You’ll be back on a boat or on a basketball court before you know it.”

Michael scrunched his eyebrows. “I’m groggy, but I know I don’t play basketball.”

Harold smiled at Peggy as Michael closed his eyes. “Let’s go see Mr. Neal,” he said.

----------

Troy Neal had his bed inclined just enough so he could stare at the liquid breakfast that sat on the tray before him. “Good morning,” Harold said when they arrived. “I’m Dr. Jackowitz, we’ve met briefly before.”

“You work with Dr. Tilson. I hope one of you will let me go home soon.” Troy scratched the unshaven stubble on his chin and looked pleadingly at the both of them.

“Except that you’re still running a fever, Mr. Neal. Dr. Tilson thinks that cleaning out the abscess yesterday went fine and it won’t need to be done again. He’ll get you discharged one of these days, I promise.”

“Actually, Dr. Jackowitz,” Peggy said, “Mr. Neal had a higher temp last night.”

Troy gestured for the hand towel near Harold as he contorted his face and vomited a small amount of fluid. Harold slid his hand and the towel underneath his chin. “I’m sorry,” Troy said. “I didn’t know that upchuck was coming until it was too late.”

Peggy grabbed the cloth, gave him a new one, and stepped to the sink to wash her hands with Harold.

“Accidents happen,” Harold said, returning to Troy. He listened to Troy’s chest and wrapped his stethoscope back around his neck. “Dr. Tilson will see you the next time. For today, you’re not going anywhere.”

----------

That evening, Danny’s ex-wife, Sara, felt ambivalent about going to the original Tilson’s family residence. The girls were also coming. Mary wanted to show Sara bridal magazines so they could pick out Sara’s maid of honor dress. Sara figured the chances of Danny being there were fifty-fifty. She had avoided any lengthy time with him except when it came to matters of their daughters, Annabel and Nancy, and legal matters were pretty much in the past as well. Danny’s affair had marred her femininity. She thought they had a solid marriage but the end of it signaled to her just how fickle life really was. His infidelity stung like a wound that had healed but the scar still remained.

Since Danny appeared to be getting his integrity and professionalism back the last two months, he also seemed willing to help her more often with the girls. He had requested to spend time with her … to talk or go fishing. She was too fragile to accept. She thought Danny had suffered enough after his affair as well as from the gaggle of pursuing attorneys. His troubles had been potent but condensed into a compact time frame. Her blow wasn’t as sharp all at once - it lingered longer like a slow bleed. Her greatest comfort was her two teenagers. Though losing her oldest daughter, Melissa, had almost devastated her, at least Melissa hadn’t suffered through the upheaval of her parents separation and later divorce.

Sara and the girls peeled out of their CRV in Mary Tilson’s driveway and headed to the front door. Annabel, the oldest girl, knocked and entered. She took off her baseball cap, laid it on the entry-way table, and crouched to greet Dakota who came bounding through the passageway. Sara and Nancy waited for Dakota to greet them, too.

A jovial male voice sounded from the kitchen. “By Dakota’s response,” Casey shouted, “we know you aren’t a pack of burglars. Good timing because the master chef has kabobs on the grill.”

Dakota swayed his tail back and forth and led them to the back where the big patio doors let the early evening light stream into the kitchen. Casey and Mary stood on opposite ends of the island but met Sara and the girls, giving them big hugs.

“Hey, what’s the long look for?” Casey asked Nancy.

“She always has a long look,” Annabel chimed in, flashing her auburn eyes at Casey.

“Better than what you look like,” Nancy said.

“Enough, girls,” Sara said.

“It smells good out there,” Annabel said.

“He’s a good cook,” Nancy said, “but Grandpa’s restaurant was better.” She straightened her hair and hid her ears because she thought they were too big. She rubbed Dakota’s back end which pushed against her legs.

“Nancy,” Sara said, “will you please be polite!”

“What, like Annabel?”

“Oh, pleeease,” Annabel chimed.

“You two better watch it,” Casey said. “I’m going to become your uncle, which will give me the right to ground you both.”

“Casey, you already have my permission,” Sara said. “And you probably had Danny’s a long time ago.”

Casey winked at Annabel who ran her tongue over her braces.

“Okay, muscle man,” Mary said, “why don’t you check on our dinner? I need to show Sara and the girls some dress options for the wedding.”

“Yes, gorgeous.” Casey put his hand into her mid-shoulder length hair, found her neck, and gave it a quick massage. “And despite what Miss Sulky says,” he said looking at Nancy, “my grilled dinner gets five stars.”

Mary showed Sara and the girls the dresses she had in mind. “I personally like the brownish-purple color for Fall and the knee length,” Mary said pointing at side-by-side magazine pages. “We can do the elbow length sleeve if you all would like.”

“I think these look fine,” Sara said. “I like the gathered fabric at the waistline. What do you think, girls?”

“Cool,” Annabel said. “I’ll be able to wear it for Senior Prom next Spring, too.”

Nancy snickered. “If it still fits you by then.”

“I’ll fit in it when I’m twenty, egghead. I’m more active than you’ll ever be.”

“Okay, if it’s settled,” Mary said, “I’ll buy them and you three need to get fitted soon.”

“By the way,” Sara said, “you haven’t told us. Where are you going on a honeymoon?”

“We’re talking about going to my previous stomping grounds in Alaska. Casey hasn’t been there. Besides, I still have artwork in a gallery which I need to decide about.”

Annabel lowered her head. “Melissa would have been in college there by now, Mary.”

“I know, sweetheart. I know.”

----------

When Danny arrived home he found everyone eating dinner on the patio, including Sara. He opened a back door as Dakota anxiously awaited to greet him. “Hey, Dakota.” Danny rumpled Dakota’s wavy coat as the dog weaved between his legs.

“We’re about finished but we saved you some,” Casey said, as he stopped scraping the grill clean.

“Thanks,” Danny said. His heart quickened when he focused on Sara. “Hi Sara, it’s nice to see you.”

“You too, Danny,” she said. He showered her with a spirited smile and she noted his genuine rapport with Dakota.

“Hey Dad,” Nancy said. “We’re coming over this weekend.”

“Good. I hope you don’t mind that Julia will be here, too.”

“That’s big news, Danny,” Mary said. “Don’t you think we need to get a little prepared? Babies need special things, you know.”

Danny shot a wistful glance at Sara. “I know, I’ve had experience.”

“Dad,” Annabel said, “there are a few old things in the basement at the house. You and Mom were a bit like pack rats.”

Danny looked at Sara. “That’s fine with me,” Sara said. “You girls can bring over any baby items you find.”

“I’ll help you buy anything else, Danny,” Casey said.

“Thanks.” Danny took the platter which had the last kabob and pushed the meat, onions, and peppers off the skewer. Mary went in the house for another wine glass, and placed it in front of him.

“Annabel has good news,” Sara said.

Rotating her head to show everyone, Annabel raised her upper lip as much as she could.

Nancy shook her head. “What is that supposed to mean, you idiot?”

Annabel shot her a fiery glance. “Why don’t you car wash the inside of your mouth!”

Casey went over to Annabel from behind and gently gave her a head lock. Annabel reached up and pushed his arm away. “When are you getting your braces off?” Casey asked. “You haven’t even had them on that long.”

“In time for the wedding.” Annabel beamed.

“The orthodontist said she didn’t have much of a bite issue,” Sara said. “The crooked tooth has straightened and aligned with the others.”

“Congrats on that,” Danny said. “That’ll shave time off your teeth cleaning.”

Annabel shook her head. “At least I won’t look like a dork in the wedding pictures.”

“Who says?” Nancy said.

“Come on girls,” Mary said, before they lit into each other again. “Let’s clear the table. Your Dad can finish eating.”

Sara went to get up. “No,” Mary said. “You finish your wine.”

Mary, Annabel, and Nancy went in the house with dirty dishes. Dakota watched but stayed alongside Danny.

“I’ll be back,” Casey said, following them, “with another bottle of wine.”

After putting his fork down, Danny moved his chair closer to the iron table. “I’m glad you stayed for dinner, Sara. We don’t get to talk one on one.”

Sara felt comfortable after taking a few deep breaths, enough to look at him, especially after the wine had taken the edge off. They didn’t have difficult divorce matters to contend with now, so she needed to relax.

“But I’m here for other reasons, Danny.” Sara opened her palm, splaying her fingers to suggest a handful of reasons.

“I know.” Danny allowed a silence, enough to let him concentrate on her orange-ginger aroma from her hair products. “You look so pretty right now. You usually do. I never used to tell you that often enough.”

“Danny, please don’t.”

“Okay, but it’s true, and it’s how I feel. I wasn’t too bright but I did make an excellent choice for a wife. And the girls have the best mother.” He smiled but then the smile dissipated from his face as he looked into her eyes. “Sara, I miss you. I really do.”

 

 

Chapter 4

 

Except for Matthew Jacob, the newest and youngest surgeon of The Neurosurgical Group of Middle Tennessee, Bruce, Danny, and Harold had full office schedules on Wednesday. It started out partly cloudy as Danny left the big house, but by mid-morning the steady rain outside the office windows amplified the weather channel’s dreary updates.

Danny finished seeing a regular patient for intracranial hypertension with a VP shunt and slid into the kitchen where Harold contemplated his cup of coffee.

“What, lousy coffee today?” Danny asked. “Not if Cheryl made it.”

“Did I hear my name?” Cheryl asked as she walked in and gave Danny the next patient’s chart.

“I was referring to the fact that you’re the best coffee maker around here,” Danny said. He rolled out a laugh. “Not to mention you’re a crackerjack nurse.”

“Thanks Dr. Tilson.”

Danny furrowed his brow wondering about his colleague. Harold sunk his forehead into his hand as he leaned over the counter. Cheryl hesitated from leaving.

“Dr. Jackowitz,” she said, “are you okay?”

Harold sat down next to the table, crossed his arms in front of him, and briefly closed his eyes. “I suppose I don’t want any coffee after all.”

“Harold, you look like you’ve been beaten down by a good party.” Danny said, pulling a chair next to him. “Do you want us to get you anything else?’

“No, it’ll pass, whatever it is. I feel nauseous and my head is starting to hurt.”

Bruce walked in with a long stride, his ironed lab coat a bright white, adding to the crispness of his professionalism. “I just put another patient on an upcoming O.R. schedule,” he said, “to have a lumbar laminectomy. Where are all these back patients coming from?”

“They all get referred to you, Bruce,” Danny said.

“As it should be.” Bruce looked above his new bifocals, evaluating the situation. “Is there group therapy going on here?”

“Harold needs some doctoring,” Danny said.

Harold shook his head and slowly stood up. “I’ll be alright. Must have been something I ate.”

----------

By 3 p.m. the rain had intensified. A few patients called to cancel appointments due to tornado warnings around the area so Danny, Bruce, and Harold tapered their hectic pace. Danny asked Cheryl to bring him the next patient’s chart, went into his office with a soft drink and took a granola bar from his desk.

Cheryl followed and handed Danny the file. “New patient,” she said, pulling her hair together and sliding it into a pony tail band.

“Thanks.”

“This is the lady sent from the ob/gyn doc that gave you a call.”

Cheryl turned to leave. “By the way, despite Dr. Jackowitz’s best attempts, he’s looking worse by the hour.”

“Thanks, Cheryl. Why don’t we check on him after this next patient?”

“I’ll corner him the next time he comes out of a room.”

Danny read the notes sent from the other doc. He realized it was an interesting case as he polished off the oatmeal bar. Wanda Robinson had a complicated emergency delivery two months ago with copious bleeding and then had difficulty breast feeding. She also reported other symptoms which suggested a lack of hormones or a problem with her pituitary gland, which could have occurred due to blood loss and low oxygen delivery to the gland during that time. The obstetrician referred Mrs. Robinson to an endocrinologist and Danny.

Danny hurried down the hall to her examination room. He greeted her with a handshake. “It’s not often we see recent obstetric patients,” he commented.

In her early thirties, Wanda Robinson had small circles under her eyes, a slumped posture, and lackluster eyes. She nodded and said, “First time I’ve ever been to a neurosurgeon’s office, too. I’m taking all sorts of journeys after having my baby.”

Danny thought of Julia as well as Rachel. Hopefully Rachel was more the picture of health taking care of their child than the poor woman sitting before him. He hadn’t seen his baby for a long time either, a situation he hoped would be remedied next weekend.

“Have you seen the endocrinologist yet?” Danny asked.

“Yes, she took all sorts of blood and we’re waiting on the results.”

“Good. Mrs. Robinson, what your obstetrician, endocrinologist and I are thinking is that you may have an underproduction of hormones since your delivery. The hormones are made in a gland which is small and inside your brain, the pituitary gland. Anyway, it’s called Sheehan’s syndrome and treatment would be to replace these hormones.”

“The endocrinologist would do that, wouldn’t she?”

“Yes. However, your other doctors are being careful. That’s where I come in. We should check for other reasons for your symptoms, such as a pituitary tumor. When we assume something in medicine, that’s when we overlook something else that is the cause or another reason for an illness.” Danny smiled. “Does that make sense?”

“Yes, I see what you’re saying.” She let out a big sigh and uncrossed her legs.

Danny asked Wanda to sit on the table, examined her, and considered their options. “What I’d like to do is get an MRI to check the size of your pituitary gland.”

Wanda took the paperwork he handed her. “Thanks, doc. I hope we’re doing it for nothing.”

“Me too Mrs. Robinson, and enjoy that baby of yours.”

----------

Cheryl signaled for Danny to step into the kitchen where Harold reclined in a chair looking pale. His lab coat hung over his legs and his hand was hidden in his pants pocket, but he wasn’t clanking change like usual.

In two steps, Danny leaned down near Harold’s expressionless face. “Harold, why haven’t you stopped seeing patients? I hope you don’t feel as bad as you look.”

“Danny, my head hurts worse.”

Cheryl inched in closer, too. “Do you mind if I take his temperature?”

Danny nodded as Cheryl placed the thermometer under Harold’s tongue.

“We’re canceling the rest of your patients for the day,” Danny said. “Bruce and I shouldn’t see them because we still have a few ourselves and we should let staff go home on time because of the bad weather.”

No sooner did Cheryl take the thermometer out of Harold’s mouth, when he peeled between Danny and Cheryl and headed for the sink. The light amount of food he’d eaten early in the morning came spewing out of his mouth like liquid chili.

----------

All Danny wanted to do that evening was unwind and relax. He stopped at a local Italian chain restaurant for take-out after leaving the office and called Mary to let her know. At home, he placed the pizza on the counter while Dakota went mad over the aroma steaming from the cardboard box.

“Dakota,” Danny chided, as he sat on an ottoman. “Are you going to continue begging or give me a proper greeting?” Dakota responded briskly and nuzzled into his hands while Casey’s Jeep pulled into the garage and the house door opened. He came in wearing gym clothes that fit snugly over his chest and part of his arms. He could have impersonated a personal trainer.

“Good timing,” Danny said. “Now you can eat half that pizza, and undo what you’ve accomplished the last one or two hours.”

“Hey, watch it. I’ve already accomplished a decent body, it’s the maintenance I’m after.”

“I’m the one who should be hitting the gym.”

“You’re not too bad, considering.” Casey tossed his bag on the side of the couch. “Is Mary still working upstairs?”

“Must be. I phoned her I was coming. She’ll be down in a minute, she must have heard our cars pull in.”

Danny and Casey both grabbed paper plates, slices of pizza, and iced tea and sat back in the great room as Mary came down.

“Hi guys,” she said. “I’m finishing up a masterpiece.” She had on denim shorts and a cotton white tee-shirt with advertising, both sprinkled with colorful paint. “Wow, does that smell good.”

“Did you call the Alaskan Sitka art gallery today?” Casey asked.

“I did. I told the owner we’d be there in the Fall and I’d make a decision about my remaining paintings. He seemed awfully concerned I was getting married.”

“I would be, too,” Casey said, “if I weren’t the one marrying you.”

Mary strode into the room, toeing in her right foot as usual, and grabbed a slice. Dakota sat at her feet staring with full attention.

“I was swamped with emergencies today,” Casey said. “I think everyone is having their trauma or medical problems now to wrap up the summer months.”

Danny finished chewing. “We’re overflowing, too, and four of Harold’s appointments didn’t get to see him because we sent him home early. Rare for any of us to get sick, but Harold’s got something.”

“Poor Harold,” Casey said.

“He can be a weasel, but we treated him nicely.” Danny tacked on a few chuckles.

“Oh,” Mary said, “Sara drove the girls over this morning. They put a crib upstairs in the guest room Melissa used to use.”

Danny’s heart fluttered when Sara’s name was mentioned. “That was nice of them.”

“It’s not assembled. It was in a box, I guess stored away.”’

“Want to tackle that project after eating?” Casey asked.

“For sure,” Danny said.

----------

The next morning, Danny glared down into a patient’s moist gray matter, contemplating the area of meninges to biopsy. He stepped away from the patient’s exposed brain and the cacophony of beeps and valves from the anesthesia machines and studied once again the MRI on the wall’s imaging screen. He stepped back and glanced towards the instrument tray. “Scalpel,” he said.

Danny made a little incision of irregular-looking brain tissue and dropped it into a small specimen cup that the scrub tech held over the tray. “For pathology,” he said. The circulator took care of sending the specimen off while Danny further examined the area.

“You’re awfully quiet up there,” Danny said.

Dean, the anesthesiologist, peeked around to see Danny more clearly. “I’ve been chasing the patient’s high blood pressure since we started.”

“I was wondering about that. Lucy Talbot was in here the other day and she can be chatty, but she had her hands full, too.”

“Our group cherishes her. She’s a good doc and gets along with everybody. I haven’t seen her today, though. I think she may be out sick.”

Just then the intercom sounded and the circulator put the pathologist on the loudspeaker. “Danny, it’s Devin. You sent down a fine specimen. It’s a non-cancerous meningioma, just like we suspected when we talked.”

“Clear cut pathology then?”

“For sure, Danny, it’s a pathologist’s dream.”

“Okay, thanks. See you at the next medical staff meeting.”

Danny and Dean both exchanged looks of relief as Danny’s pager beeped. “It’s the office,” the circulator said as she dialed the number. She talked to Bruce and then hung up. “Dr. Garner said that Harold is in the E.R. He’d like you to see what’s going on when you can.”

“Did he mean as a patient?” Danny asked.

“I believe so.”

Everyone’s tasks seemed to hurry quicker than normal as it was obvious Danny needed to go check on his colleague. When he finished aligning the skull piece and suturing the scalp, Danny stepped back and removed his gloves as the OR head nurse overseeing the schedule walked in.

The nurse nodded at Danny and then addressed her staff in the room. “Can you two stay over after your shift today? We’re backed up and I’m already missing Dotty and James.”

She barely waited for their reluctant okays when she spun around again and left mumbling, “Dotty and James better be sick.”

Dean unlocked the foot pedal and swung the table forty-five degrees back to him. “We’re okay here,” he said to Danny. “I’ll have him extubated and in recovery room soon.”

“Thanks Dean. Thanks everybody.”

As Danny walked through the lounge, he slid on his white coat. He had some time between cases to visit the ER and didn’t have to hustle. In any case, he bounded down the steps to the first floor. With regular shift hours, Casey had the luxury of going to the gym. Since Danny wasn’t so lucky, he made sure he frequented the hospital staircases instead of the elevator.

On the ER schedule board, Harold was listed in room 5. Danny turned the corner to a semi-closed door where he saw the ER doc inside talking to Harold, who lay supine on a stretcher. Danny decided to give them some privacy as Casey and his partner, Mark, pulled a stretcher through the hallway and stopped at room 6.

A flurry of personnel surrounded the stretcher as they pushed it in the room. Casey gave them a report and the man they brought in succumbed to hands and monitors being placed all over his chest. The man’s right calf had shattered flesh and dripping blood and the crumpled sheets were crimson. An ER doc curved around Danny, went in, and took charge. The fast talking doc spoke with Casey as she stopped to eye the EKG.

“He had chest pain at the same time?” she asked Casey.

“Precisely,” Casey said. “He shot himself in his leg while cleaning his gun, which I think precipitated angina.”

“This is a heart attack in progress, I believe.” She stood alongside the stretcher and shook her head.

The man grinned. “Guess I won’t be cleaning my gun again anytime soon,” he said slowly.

“It doesn’t look like you’re too proficient in that skill,” she said.

She whirled around. “Thanks Casey. Nice work, fellas.”

Casey and Mark both left the room, but Casey stopped. “Meet you back outside in awhile,” Casey said, handing Mark their residual paperwork.

“Remind me never to do that to myself,” Danny said.

Casey nudged him away from the door. “He’s lucky. He could’ve shot himself in the head and then he’d have you taking care of him.” His smile broadened.

“Shut up, Casey. You’re just an ambulance driver anyway.” Danny laughed softly.

“Okay, so what’s the deal with Harold?” Casey pointed towards the next room.

“I haven’t gone in there yet.”

“He came in by another ambulance. Mark and I couldn’t take the call. We were out on this one.” He nodded towards room 6. “I can’t imagine he called an ambulance.”

“He’s not married and I bet he didn’t want to disturb his parents. He should have called the office and one of us could have looked in on him or fetched him.”

A spindly-legged woman in high heels slowed almost to a stop. “Excuse me,” she interrupted. “Hello, Casey, if you need any more help from the business office, don’t forget my name.” She emphasized the last four words and Danny felt like an intruder.

“Thank you, Monica,” Casey said. “I think I’m all set.”

The woman continued on her way, her heels drowned out by the sounds of the ER.

Danny looked up from the floor. “If Mary ever saw the number of women at work who fall at your feet, she’d wonder about fighting off competition the rest of her life.”

Casey shrugged. “But you know she doesn’t have to.”

A trauma surgeon passed them both, nodded hello, and entered room 6. “The trauma docs are always so fast to get here,” Danny said. “Looks like your patient will need them as well as cardiology.”

Casey reached over to Danny, tapping him on the arm as the door fully opened to room 5. “Looks like you can go in.” The ER doctor and a laboratory technician with blood samples both came out of Harold’s room.

“Okay,” Danny said. “See you tonight.”

----------

Danny approached the stretcher where Harold’s legs splayed apart as if the paramedics had dumped him there. He wore a pasty color like the ghostly looking sheets beneath him. As Danny stopped, an attack of shivering sieged Harold from head to toe. And along with Harold’s lack of affect, he wore bags under his eyes like a drugged-out insomniac. A dreadful worry passed through Danny as he examined his colleague, making him take a long, soulful breath.

“Harold,” Danny whispered.

Harold’s eyes fluttered open. They lacked moisture and after a few seconds, they registered recognition. “Danny?”

“Yes, it’s me. You should have called one of us last night if you needed help.”

Harold moved his head slightly to the side, but then gave up. “No. That’s okay. I called you today. I still have a headache.”

“You’re being admitted, aren’t you?”

“Yeah, you can come see me.” Danny waited patiently as Harold tried to find his words. He straightened the pulse oximeter probe clipped on Harold’s index finger, which registered 96% on the monitor. “I’m going to cause a strain on the practice,” Harold continued, “my being in here.”

“You focus on getting rid of whatever you’ve got. They’re working you up already, and once you get admitted, we’ll get to the bottom of this.” Danny patted his arm. “I’ve got to run for my next case. I’ll check on you later.”

While running up the stairs to the second floor, Danny’s pager beeped. He entered the doctor’s lounge, poured a half cup of coffee, and sat in front of a phone. He dialed the number of the nurses station on one of their neurosurgical wings.

“Dr. Tilson,” Danny said, when someone answered.

“Dr. Tilson, this is Rob. I’m taking care of Troy Neal this afternoon. His fever has spiked higher, he vomited a light lunch he had, and we also just discovered a nasty bed sore that he kept us from seeing.”

“I’m headed into surgery, Rob. I’ll be by afterwards. In the meantime, call his internist who’s been following him peripherally. Ask her to come see him.”

Danny got off the phone. When it rains, it pours, he thought. He pushed the morning’s developments to the back of his mind and looked at the recent CT scan report on the computer screen for his next patient.

 

 

Chapter 5

 

At Bruce’s request, Danny headed to the office after his surgeries. As soon as he entered, Bruce signaled him and Matthew Jacob, their junior colleague, into his office and started tossing questions Danny’s way.

“What’s wrong with Harold? Is there any chance of him working in the next few days?”

“He’s admitted and it’s too early to tell. And I don’t think so, at least not until Monday.”

Bruce shoved some folders to the side and leaned on his desk. “What’s the admitting diagnosis?”

“I think they put flu or flu-like illness.”

“It’s not exactly flu season,” Bruce said.

A lengthy silence followed. Bruce looked square at Matthew. “Harold was on call this weekend. One of you must cover. Matthew, are you game?”

Matthew shifted his gaze from Bruce, which wasn’t an aversion to the question. Their newest colleague avoided most eye contact yet listened well and never missed details.

“Not practically speaking. My new brother-in-law is getting married and I’m one of the ushers. I have the tux, there will be pictures, the reception, etc.”

Bruce eyed them both. Matthew turned to his side, facing Danny. His favorite pastime with his wife was running, which made his profile skinny as a dime. “Honestly,” he said, “I don’t know if I’ll even have time to run this weekend.”

A frown etched across Danny’s forehead. “Bruce, you can count on me if you can’t do it.” Danny knew he’d pulled his weight and more since he’d returned and that he stood in Bruce’s good grace. “The reason I say ‘if you can’t do it’ is that I finally have visitation and I’m bringing my baby to the house this weekend.”

“Danny, I can’t. My wife and I are headed out of town for a birthday celebration. And this old man can’t pull that kind of call too often anymore.”

Danny shook his head. “I guess we don’t have a choice. I’ll cover.” A pang of despondency gripped over him as he struggled not to show it.

“Danny, sorry about the timing,” Matthew said.

“Danny, there will be hundreds of visits with your daughter,” Bruce added. “By the time she’s eighteen, you’ll be begging for an Ivy League school to take her off your hands.”

“I wish that were true, Bruce. She’s not in my hands.”

Bruce got up quickly from his chair. “Now, what about Harold?”

“I’m going back over after I get paperwork and chart work done,” Danny said. “I’ll check on him.”

----------

Rachel had snagged another perk by living with Leo – his finished basement. On one side against a white wall and full length mirror, he had an assortment of cardiac machines. Racks of dumbbells lined another wall and the back of the room had resistance equipment as good as any found in a major athletic center. A large mat covered the entire middle section of the floor.

After lunch and Julia’s nap, Rachel brought her daughter, her cell phone, and a bottle of water downstairs. She placed Julia on the mat, grabbed the cardboard box she kept there, and sprinkled out an assortment of toys. Julia’s hand reached for a green plastic turtle on wheels. To Rachel’s satisfaction, her infant became amused and pushed it along with her fingers.

Rachel turned on the overhead TV and spied on her new sweat suit in the mirror. The pale blue, light weight cotton suited her. She was proud of herself for using his gym three days a week. Some things had gotten so much easier. Before using Leo’s equipment, she had never rowed, but nowadays the rowing machine had become her favorite so she adjusted the settings first.

At thirty minutes, Rachel wore a light sweat. She slowed the pace for two more minutes and got off. Guzzling from her water bottle, she pushed another animal toy towards Julia, who had kept pensive. It seemed like her infant had turned a milestone and was mostly quiet these days. Rachel contemplated the treadmill next as her cell phone rang. The incoming call registered from Danny Tilson. Rachel hesitated, wondering how to prepare her response to whatever he wanted.

“Rachel,” Danny said when she answered. “I was looking forward to having Julia with me this weekend, but something uncontrollable has come up. Can we postpone my visitation to the following weekend?”

“Danny,” she crooned, “after all your gallant claims about wanting to have Julia, now you’re saying she’s not your priority?”

Danny gulped at her insidiousness. “Rachel, why are you so mean?”

“Wow. Mean? You’re the one who stole my dog.”

Danny almost blurted out that she had stolen his Einstein book, but he stopped. “Back to the original question,” he said. “If I have to call Mark Cunningham, then I will. But I thought you didn’t want me to have Julia, and you’d be pleased.”

“Out of the goodness of my heart, I will accommodate your schedule.” She eyed the treadmill as Danny ate into her time.

“I appreciate that. Let’s keep the same arrangement for next week then.”

“Bye, Danny,” she said nicely and ended the call.

Rachel grinned. Now she was holding the short end of the stick with Leo. She hadn’t let Danny know about her Saturday predicament needing a baby sitter because Danny didn’t know about her part-time job. Leo, on the other hand, wouldn’t tolerate some baby sitter in the house, or most baby sitters in his house, and her instincts told her he wasn’t going to jump for joy to mind Julia again, either. She’d have to make it worth his while.

----------

After finishing her work out, Rachel showered and changed, put Julia in the car seat and drove to a nearby restaurant for take-out. She took care of Julia’s needs back at the house and finally put her to bed. Rachel ate and waited for Leo, who didn’t walk in until 8 p.m. She untucked her legs from underneath and glanced back at him from the television with a sensual smile.

“Hey, babe,” he said. He locked onto her eyes as he went over, the smell of beer on his lips as he kissed her.

“I’ve got a flank steak and fries over there for you,” she said.

“I’ll check it out. I had a meeting with a hospital administrator and then we had a few beers, but we didn’t eat.”

“You don’t have to explain yourself to me.”

“I won’t unless I want to.” He ambled over to the counter and opened the Styrofoam container. He dumped the contents onto a plate, zapped it in the microwave and pulled up a stool. Rachel poured them both a glass of wine.

Rachel ran her finger around the rim of the glass when Leo pushed away his plate, the last piece of meat still remaining. “We should go to bed early,” she said.

Leo eyed her - her aqua eyes, summer highlights, and open neck white blouse. He stood and came close, unbuttoning the top buttons of her shirt and running his hand down into her cleavage. When he brought his hand out, he undid his zipper, put his hand on her head and pushed her down. With his other hand, he greedily pushed himself into her mouth. When the pressure on her head abated, Rachel finally got up off her knees. Leo’s lust was becoming lecherous. She went to bed and after an hour, he came walking into the bedroom, his last cigarette of the day dangling from his lips.

“Did you have fun playing Mommy today?” Leo asked, getting on the bed.

Rachel felt the hair on her neck rise from annoyance, but perhaps she misread him and his gruff tone. “I did. I’m still working the day after tomorrow, though, and Julia is staying home after all. There was a change in plans. I know you’ll look after her just fine for me. Is that okay?”

Leo propped his bare arm behind his head, leaned against the pillow, and sneered. “She’s not a problem. After all, it’s like having a part of you here with me.” He dragged what he could out of the end of his smoke and squashed it out on an adjacent ash tray.

----------

The hallways of 4 East bustled with activity and it wasn’t even shift change. Another doc made rounds as a staff member followed her with a rolling cart stacked with bulky charts. It was mostly The Neurosurgery Group of Middle Tennessee’s hospital wing, but a few general surgery patients took up beds and other doctors came by for consults after their office hours. Danny nodded at the general surgeon as she passed and then settled at the nurses station to get the charts he needed. Before seeing Harold, his patients came first. He hoped the internist had been by to see Mr. Neal.

“Hi, Linda,” Danny said, eyeing the name tag on the nurse’s scrubs. “Is Peggy here?”

“No, Dr. Tilson. I’m one of the part-timers. She’s out sick.”

“That’s too bad. I hope she gets better.”

“Me too. I don’t want more hours if nursing gets more short of help.”

“I understand. Do you know where Mr. Neal’s chart is?”

She nodded and took a few arthritic steps away to a dictating desk. She came back and handed Danny the chart. “Dr. Patogue came by to see him.”

“Thanks.” Danny sat and flipped to the newest progress note. He scanned the doc’s reiteration of Troy Neal’s admission diagnosis and hospital synopsis. The last few lines described a two by two inch broken down skin sore on the patient’s buttocks. Along with Mr. Neal’s recurrent fever and failing hospital course, Dr. Patogue thought he may be septic and had ordered a work up. He planned on starting him on new I.V. antibiotics.

Danny hurried into Troy’s room with Linda lagging behind. His patient’s scrawny hands lay over his abdomen. They didn’t move when Danny approached him.

“I guess we’re still not unwrapping your head bandages,” Danny said, “until I get another CT of your head to make sure we’re cleared up in there. Now you’ve got another problem to contend with. Or perhaps it’s been the real culprit the last few days.” Danny grinned at him, but Mr. Neal only put a frown on his lips. His face was more drawn and he sputtered a few coughs.

“What’s sep tic, Doc?” Troy asked between breaths. “That other doctor told me but hell if I knew what he was talking about.” He pointed at his abdomen like he was going to vomit, but then coughed and spit out phlegm into a tissue.

“It means you have an infection in your blood stream.” It didn’t make an impression, so Danny added, “It can be a serious medical condition.”

“Should’ve told someone my butt was in trouble, right?”

“Yes, Mr. Troy. Now you get some sleep.” Danny dimmed the light as he left.

After Danny saw a few more patients, he looked over Michael Johnson’s chart. A normal postop fever should be gone for him as well. He thumbed to the nurse’s notes, although no one had called him with any new developments. An entry from the last shift nurse mentioned Michael complaining of a headache again, or maybe it had never left. Danny shook his head - kids weren’t always the best historians. Another note mentioned copious mucous or expectorant and several entries said ‘patient sleeping.’

Danny made his way to the room farthest down the hallway with Linda following. Inside the darkened room, the long teen stared hazily at the TV. Danny stood right beside him, but the teen seemed half asleep. Michael pushed his tongue out to his lips stirring the secretions all around his mouth. “Michael?” Danny said. He received no response. Danny picked up the bedside chart. Last temp recorded - 101.8 Fahrenheit.

“Linda, have his parents been by today? I haven’t seen them in a day or two.”

“No, Dr. Tilson. Actually, I was told they went on a two day trip. They should have been back, but the charge nurse couldn’t reach them this morning.”

With Linda’s assistance, Danny removed Michael’s head wrap and found nothing amiss. “Let’s get him to C.T. for head imaging, please, as soon as possible.”

When Danny left, he ran up two steps at a time to the medical fifth floor to see Harold. He swung open the heavy door as three medical employees, a crash cart, and an anesthesiologist whizzed by. Danny made a right turn for room 525 down the hall. Visitors and a nurse putting pills into little patient cups from a cart cleared the way for all the commotion. A doc’s worried face poked out from room 525 and signaled to the group of personnel heading his way. It was Bill Patogue, the internist. “In here,” he said loudly.

Danny ran. Harold must be in a single patient room. It had to be Harold who was getting all the attention. He carried up the rear of emergency medical workers as they swarmed on Harold. Through the hands and bodies putting on EKG patches and suctioning secretions, the anesthesiologist pushed himself between the wall and the head of the bed. Dr. Patogue threw him some rubber gloves. Harold’s lifeless-like body wasn’t dead when it came to an overabundance of wet, clear, sticky secretions over his mouth, down his chin, and flowing to his ears and hair.

The anesthesiologist leaned over to the top of the red cart, grabbed a laryngoscope and an adult-sized endotracheal tube and then opened Harold’s mouth. With trembling hands, the respiratory therapist handed him the suction catheter. The anesthesiologist interrupted trying to intubate him, moved the tip all around Harold’s mouth, and advanced it further into the back of his throat. The continuous slurping sound made everyone’s heart quicken. He switched what he had in his hands again. As fast as possible using the laryngoscope, he made his way through the secretions with the tube and into Harold’s trachea. The endotracheal tube and the ventilator were now going to do Harold’s breathing for him.

----------

The sun hadn’t sunk all the way down past the horizon when Danny pulled into the driveway. As Casey pumped insect repellant onto a small Japanese Maple on the front lawn, Dakota ran to the car and anxiously waited for the door to open. Danny stepped out and gave Dakota a spirited greeting.

“Look at this,” Casey said after putting the spray bottle next to his sneakers. He turned over a purple leaf. “Japanese beetles everywhere.”

Danny’s finger flicked off one of the copper-colored, hard insects. “Great. What about the maples in the back?”

“Not as many, but I’ll spray those, too.”

Danny pointed over to the front step. “Mind sitting for a minute?”

Casey brought the canister over with them and Dakota followed. When they sat, Danny picked up a tennis ball alongside the path, and threw it. Dakota’s eyes tracked it while his body raced across the lawn.

“Good boy,” Casey yelled. “At least you inherited a winner, Danny.”

Danny’s eyes sparkled. “That dog has drilled a spot in my heart.”

Dakota leaped three feet into the air, caught the ball on the fly, and sprang back to Danny for more. “I’m sorry to say if you needed help around here this weekend, I’m out of the loop. I feel bad about it, too. Half the time I think I should be out of my Mom and Dad’s house anyway. Mary has more rights over it than I do. You two…”

Casey cut him off. “We’ve been through that before, so shut up about it. You getting your own place still doesn’t make sense. This place is huge. And plus, we want Dakota here as much as you.”

Danny grimaced. “All right, but after your wedding, we better talk about it again.” Danny threw Dakota the ball again, higher and farther, but the yellow fuzz was getting harder for Danny to see in the fading light.

“Harold not only was admitted today,” Danny said, “but he’s in the unit on a ventilator. I don’t have a clue what’s happened to him. And as you know, Julia was coming this weekend. I had to call Rachel and postpone because I’m going to take Harold’s call.”

Casey stretched his legs forward and leaned back on the palms of his hands. “How’d that go over?”

“She’s a trip. Julia’s worth ten times the mother.”

“Have you told Annabel and Nancy?”

“No, but they love being with you two anyway. Maybe they can come next Saturday, too. I’ve rearranged Julia’s visit for then.”

----------

From the moment she woke after nodding off to sleep after her alarm sounded, Rachel scrambled to make up lost time. Her one freaking day to work and she almost blew it. She threw scrubs on so she wouldn’t have to change into them at the hospital; she did the basic changing with Julia; and she ran every yellow, almost red, traffic light in her CRV’s path. During the drive, she regretted that she hadn’t had enough time to give Julia her morning bottle. When she got to work, she rushed to the OR, ready to pass instruments to her present hospital’s demanding and uninteresting surgeons.

Rachel had left hours ago when Leo cracked open his eyes. The tee-shirt and cotton bottom she wore to sleep were tossed on the bedspread and a skirt and blouse still hung on the doorknob. He figured she’d left in scrubs. He also knew her baby was crying.

After a visit to the bathroom, he went to the kitchen where the bawling baby sounded a lot louder. On the counter, he found an elegantly written note from Rachel.

Leo, I didn’t have time before I left. Would you please make Julia a bottle as soon as you get up? I would really appreciate that.

Hell, he thought. She doesn’t even take care of her own kid. Blood ran faster in his veins while he made coffee. He found a clean bottle near the sink and tapped it on the counter with annoyance, then ripped open a new pack of cigarettes. Julia’s crying picked up, slowed into sobbing while she caught her breath, and then pitched back into a frenzy.

Leo jerked open a cabinet, grabbed a mug, and substituted it under the dripping coffee instead of the pot. It diverted him from going in there and ripping her apart. He gulped down a second cup, which wasn’t hot enough for him, especially since he was hotter than hell. After he lit his first smoke, he tucked the pack between his ripped bare abdomen and jockey short’s waistband. Several puffs later, he downed more coffee. Julia’s distress could be heard by deaf ears through most of the house.

The Columbian blend tasted rich and smooth. He deserved this. A day where he didn’t run off to read unintelligible doctor scrawls all day and count pills like a child. But what the hell was he doing putting up with a little human being who couldn’t talk, yet could scream like the backdrop for a horror movie? That’s what he had allowed to happen in his own place. The wailing from his guest bedroom was analogous to screeching from some species living on the forest floor.

“Crap,” he shouted. He stormed across the kitchen, threw the bedroom door further open, smashing it into the wall, and ended beside the crib. Shut up, he silently said as he grabbed Julia’s arm. But she didn’t. His temper swallowed his thoughts as he went for her arm. His hand encircled her soft puffy baby arm and he shook. But that wasn’t enough for him as her eyes registered shock. The veins around Leo’s temples bulged and his biceps stiffened as he jerked again and again on the arm of the baby that had done nothing wrong.

 

Chapter 6

 

On Saturday morning Danny arrived at the hospital with plenty of time to spare. Dakota had demanded bedside attention a half hour earlier than normal, making Danny think Dakota needed to go out, so he relented and got up. It wasn’t such a bad day to be on call after all. A late summer rain made for a dreary morning and clouds began stacking up with malicious intent.

To Danny’s pleasant surprise, he still had only two surgeries booked as well as the group’s in-house patients to see. His first case was one of Harold’s back patients who couldn’t wait for Harold’s return to work. Danny did the fewest in his group, but he could put people back on their feet without sciatica as well as his colleagues. He sat in the doctor’s lounge with a bowl of cereal and coffee. As he turned a page in The Tennessean, he heard a familiar voice.

“Danny, can I join you?”

Danny looked up at Bill Patogue’s wide grin and thick glasses. At forty-two and natty in a bow tie, the internist looked a decade younger.

“Sure, Bill,” Danny said. He pointed to the scarlet red tie. “You must be a Louisville Cardinals fan. You’re not wearing Tennessee orange.”

Bill shook his head. “My tie colors don’t make sport’s statements unless we’re in March madness or it’s a holiday.”

Danny laughed. “I could use some color, Bill. What color stands for ‘stay out of trouble’?”

Bill put down a small plate, waved off the comment dismissively, and pulled in his chair. “I’m rounding soon on Harold and my growing list of consults. Did you know that hospital bed admissions are almost full?”

“Really? That means I could have a quiet day on call. If they get full, they’d have to divert emergencies to other hospitals.”

“The growing admissions seem to be medical.” Bill buttered his toast and opened a packet of marmalade. “Anyway, I never got back to you about Harold.” He shook his head and leaned in closer to Danny so he could be heard over the blaring TV. “He’s unconscious. The blood and urine results aren’t conclusive and nothing’s amiss with x-rays of his chest. Blood and sputum cultures are pending. I don’t want to waste any time, so what do you think about getting a brain MRI?”

Danny sighed. In reflective thought, he stayed quiet for a moment and stared at his cereal. This seemed so unreal. Harold had been fine and he had no health issues which would have made him susceptible to a unique malady. Danny snapped out of his pensive look. “Sure. Let’s do it. When it’s done, I’ll take a look with you.”

“All right. Even though it’s a Saturday, I’m going to stick around a bit. I’ll call you when it’s finished, it may be this afternoon.”

Danny fiddled with the spoon in his raisin bran and glanced at his watch. “It’s discomforting that one of our own is sick. As we know, medical people have the worst luck and outcomes.”

“I hear you. My consult to see this morning works here in the OR. She’s apparently confused, with a headache and muscle weakness. It’s not even flu season.”

“What’s her name?”

“Dotty Jackson, do you know her?”

“She’s one of the OR nurses. I haven’t seen her most of the week. It may have been Monday or last week when I had cases with her.”

On the table, Bill’s pager vibrated, causing it to slightly scurry along as Danny and Bill watched. “Let me get this,” Bill said, pushing away from the table.

Danny reheated his coffee in the microwave while Bill answered his page. When he made it back to the table, Bill patted him on the shoulder. “Guess I’ll go downstairs to the ER first. The doc says it’s a hospital scrub nurse they just intubated and put on a ventilator. His mother found him unresponsive after he ran a fever all night. I’ll call you later.”

As Bill turned, Danny hurriedly asked, “What’s his name?”

“James something.”

----------

The patient on the operating room table was turned prone. Danny had good exposure into the man’s back to work around the lumbar nerve roots and musculature. Considering every surgery Danny had seen through residency or knew about, back surgery most reminded him of butcher’s work - like splayed cattle meat on a table, red and raw. Things weren’t going so well, either. The man had a platelet disorder which made him bleed more profusely.

Getting good visualization of his landmarks became increasingly difficult. At least he had Dean in the room, who had more of a challenge with the patient’s hematologic disorder than giving him anesthesia. Dean asked for two bags of platelets from the blood bank while he infused more IV fluids to compensate for the blood loss. Danny slowed down his pace so that the platelets could arrive and be transfused. They had to make headway in stopping the oozing.

Danny kept the suction tip in the open gap while waiting. Slow, steady blood was sucked into the canister. He watched Dean, who stood so tall that the IV height was easily in reach.

“I’ve never worked with you on a back before,” Dean said, glancing at Danny.

“I do them, but rarely. The head cases pile up for me, so I do backs less and less. Actually, this is Harold’s patient.”

“What’s going on with Harold? You were going to see him in the ER the other day.”

“He’s in a coma,” Danny said, concern buttering his words.

Under his mask, Dean’s expression registered alarm. His eyes widened. “No way.”

Danny moved the tip away from the patient’s back for a moment. “Dr. Patogue is taking care of him. We’re getting an MRI of his head today.”

“I hope that turns out okay. Last night I talked to Dr. Talbot. She’s headachy, crampy and not eating well, and sounded lethargic. She did see a doctor the other day. Despite a z-pack and aspirin for a fever, she’s not shaking it. I told her she needs to get in here today if she’s not getting better. Have one of our hospital staff or the ER take a look at her.”

“She’s a tiny, healthy thing, and young. I can’t imagine her being ill.” Danny furrowed his brow. “Actually, Dr. Patogue said earlier that two of our OR staff are going to be seen soon, too.”

----------

As Casey stood under the hospital overhang outside the ER, he waved to Mark to back the ambulance further in so the back doors would stay dry when opened. Their three-to-eleven shift had started with a thunderstorm. Mark got out and darted to the curb next to Casey.

They opened the rear end and climbed in to run through their check list of supplies, oxygen, and housekeeping. Casey smiled his appreciation for the spotless, equipped vehicle. He took pride in their roving work place, and even cleaned and disinfected the small rubber floor mat practically next to the bumper.

“Lousy Saturday we have,” Mark commented.

Casey counted the IV fluid bags on one of the shelves. “I don’t mind it. Thunderstorms are smart precipitation. They take care of themselves.”

Mark registered a quizzical expression as he opened new emesis basins.

“You don’t have to scrape it off the driveway.” Casey said, and then jotted down his inventory on a sheet.

“But we don’t get enough snow or ice anyway,” Mark countered.

“Nevertheless,” Casey said, “it doesn’t damage vehicles like hail pellets either, which can grow to golf balls.”

“What about lightning?”

“That’s separate, like wind. Those aren’t precipitation.”

“You’ve got this all figured out. You should’ve been a weatherman.”

“No way. I can’t separate who I am from what I do. They’re one and the same.”

The automatic doors to the ER opened and a young brunette with a loud purple scrub top came straight to their ambulance. She pushed her long silky hair off her shoulders. “Hi, you all,” she said, smiling at Casey. “Did you just get here?”

“Pretty much,” Casey said. “We’re three-to-eleven.”

“I would be telling you the beds are full and we’re on diversion, but the hospital had two early afternoon discharges, so there are two beds available. The desk just got two calls. You better come in. The other ambulance drivers are picking up the slip for the first one as we speak.”

“Okay, we’re coming,” Mark said.

Casey’s eyes flickered with enthusiasm when he stepped onto the pavement. The young lady hesitated as her face blushed. She was so close to the paramedic heartthrob.

“Go ahead,” Casey said. “I’ll wait for the better half of my working relationship.” He winked at her and she left.

Mark stepped down. “What did you do, encourage her by winking like that?”

“Heck, Mark. What do you mean ‘encourage her’?”

“Even if they know you’re not available, they could care less. They’re going to try and lure you in anyway.”

“You make me sound like red snapper on the end of a line.” Casey shrugged his shoulders then hurried inside with Mark at his heels. Two ambulance workers passed heading out as Casey and Mark greeted them. Casey waited for the ER desk secretary to give them the information.

“You just missed going on a run for an anesthesiologist who works here,” the husky voiced woman said. “A Dr. Talbot,” she mumbled. “Looks like you’re going a few miles south to the mall. Man with chest pain.” She handed them her note.

Casey ran his hand over his crew cut and the both of them turned on their heels.

----------

Danny’s cases extended into the afternoon and he still hadn’t seen everyone on the floor. At least his back patient finally stabilized with Dean’s supportive care, especially in the recovery room. Finally, the call Danny anticipated came through. Dr. Patogue had the MRI and waited for Danny in the X-ray department. He bounded down the stairs to the first floor and cut through the emergency room. He hurried faster upon seeing Casey and his partner going down the hallway towards the back door.

“Are you two on an ambulance run?” Danny asked as he sidled alongside them.

“Danny, it’s not the time for ambulance wisecracks.” Casey kept heading straight. “We’ve got a guy with chest pain.”

“I’ve only got a minute myself. I’ll follow you to the back.”

“Actually, there are two runs.” Automatic doors opened as they neared. Casey pointed to the ambulance backing out. “They’re going for a staff doc.”

Danny put his hand on Casey’s upper arm. They didn’t slow but Casey’s eyes caught Danny’s concern.

“Is it Lucy Talbot?”

“Sure is.”

Mark headed to the driver’s seat and Casey opened the back as the skies rumbled above.

“Casey, I have a sneaky suspicion that something is going on because we have a rash of sickness.”

“That’s not so odd.”

“No, this is different. I’m glad to know you’re picking up the patient other than Dr. Talbot.”

“Danny, I’d pick up anybody who needs me.”

“I know that. That’s your job. However…look, I’m not being an alarmist. You know me better than anybody. I’m going to go look at Harold’s MRI with Bill Patogue. But right now, my instinct is alert and this is just between you and me.”

“Okay, Danny.” Casey slammed the doors shut while a bolt of lightning peeled across the skies and Danny rushed inside.

----------

Danny could tell the radiology department napped on weekends when he walked through the front room. Although they took films and advanced imaging for trauma and more emergent requests, a skeleton crew and one radiologist manned the place. Danny spotted Bill and the radiologist, John, in the first dimly lit room and walked in.

“Danny,” Bill said. “John was nice enough to walk me through this, especially with my limited expertise with head imaging.”

The MRI films went from left to right on the viewing boxes and slices went from top to bottom. Danny methodically examined the images starting with the outside – the skull. The meninges was the layer closest to the skull, the membranes between the skull and brain. Danny knew it consisted of three layers called the dura, arachnoid, and pia mater, but on film it wouldn’t be like they were huge delineated layers.

Danny shuddered. These were Harold’s images - someone he shared his practice and specialty with, someone who often looked up to him for advice, someone who knew the sweat and tears it took to earn a neurosurgery degree. He wished he saw differently. Harold’s meninges on his MRI were inflamed, suspicious for meningitis.

John tapped his finger right where Danny stared. “Significant inflammation,” he said, “but also look at these high signals in the temporal lobes.”

The men took a step to the right as Danny leaned forward, also scrutinizing the hippocampus and frontal lobes. He glanced at Bill, who swiped the back of his hand along his forehead.

The double whammy hit Danny just as Bill piped in. “Inflammation of the brain, too,” Bill said, taking his bow tie off and shoving it into his pocket.

“Encephalitis,” John said.

“Worse than that,” Danny said, “meningoencephalitis.”

 

Chapter 7

 

Danny tried to leave the radiology department quicker than he got there, but Bill lagged. He waved for Bill to follow him into the staircase, but Bill took a deep breath and hit the elevator button.

“We have to talk and make a plan,” Danny said, “but first I’m going to go do a stat spinal tap on Harold. It’ll give us more information. Although we should call in a neurologist as well, we don’t have time to wait for them to do it.”

“I agree, and James, the scrub nurse from this morning put on the vent, is in a coma.”

Both men stepped into the elevator and Bill leaned against the wall.

“Are you all right?” Danny asked.

“I’m feeling hot and sweaty, but never mind about me. I’ll go get whatever lab results are back on Dotty.”

“Why don’t we meet in the doctor’s lounge at about six o’clock?” Danny suggested. “And after the spinal tap, I better go track down Lucy Talbot.”

“Lucy Talbot?”

“Yes, an anesthesiologist who’s fallen prey to something, too.”

Bill got off on the third floor and Danny continued on to the ICU. He weaved past a group of family members in deep discussion about a loved one’s care which sidetracked his thoughts. He went into intensive care with only his ex-wife on his mind. He’d get his procedure done but he gave himself the liberty of thinking only of her.

Danny grinned as he visualized Sara’s habit of talking with her hands. His eyes twinkled as he thought about her peppered blonde hair dramatically stopping in the middle of her cheeks and her subtle smell of orange-ginger. But her mind was as powerful as her looks; and her wisdom and strength underscored the loving quality she possessed for everyone and everything. That is, unless she was betrayed, but Danny still hoped to gain her forgiveness.

Harold’s nurse was in his cubicle so Danny went straight in, thoughts of Sara ebbing away. He looked at the nurse’s badge. “Marsha,” he said. “I’ll need your help straight away, if that’s possible.”

She turned down the volume of the overhead monitor. “Sure, Dr. Tilson.”

“I’m going to write some orders, hopefully get the neurologist, Timothy Paltrow, to consult on Dr. Harold Jackowitz. In the meantime, please get me a spinal tap tray and gloves. Get respiratory therapy, too, so we have an extra pair of hands for positioning him on his side and watching his endotracheal tube and ventilator connections.”