Diagnosis Death (12 page)

That's when it hit her. She was alone—totally alone. Even the memory of her dead husband was no longer there to sustain her.

Elena locked the door of her apartment. The click was like an audible punctuation mark that ended this part of her life. The last two days had gone by in a blur, but she had no wish to recapture them. All she wanted to do was move on.

When David walked through the door on Thursday night, Elena's determination not to share her news about Mark's infidelity disappeared like a wisp of smoke before the north wind. After her first few blubbering sentences, David dropped the bags of food in the living room and extended his arms to her. She wasn't sure how long he held her, but she recognized that there was more there than just a good friend offering support in a time of crisis. And, God help her, she found herself wishing she could stay in those arms.

Eventually she'd disengaged from his arms, dried her eyes, and tried to gather herself. They'd talked for over an hour after that, carefully avoiding any mention of their embrace. When David left, they'd divided the Chinese food, joking that doctors could eat anything, including reheated Lo Mein, for breakfast.

Elena had managed to fill yesterday with enough to keep her mind occupied. There'd been packing, phone calls, two trips to the dumpster, one to the local Goodwill center to dispose of all of Mark's clothing after David declined it. Elena didn't blame him.

She shoved the apartment key into the pocket of her jeans and climbed into her car. The little Ford fairly bulged with luggage and boxes. Despite Elena's intentions to take only essentials on this trip—she'd be coming back soon to meet the movers—now she wanted as much familiar stuff with her as possible. She needed security.

She punched a button on the dash, and the sweet strains of piano music filled the car. The song was "It Is Well With My Soul," and Elena thought nothing could be further from the truth right now. The CD had been a gift from a friend after Mark's death. Elena hadn't listened to it since, but now she hoped the music could help her purge the bitterness that clutched her heart.

As she passed the Dallas city limit sign, she felt she should say something to mark the occasion. Something like, "Good-bye, Dallas; hello, Dainger." No, she didn't much like the ring of that. Finally, she settled on a brief wave into the rearview mirror.

Elena drove for about an hour, navigating pretty much on automatic pilot, when she noticed the car in front of her weaving from side to side. She eased off the accelerator and dropped back a bit. If the driver was on the verge of an accident, she didn't plan to be involved in it. The car was a dark blue Buick, at least ten years old but polished and shiny as a new dime. One head showed through the rear window, silver hair that bobbed forward, then backward, like a cork on a windswept lake. Was the driver drunk? Or asleep?

She honked her horn, but there was no reaction from the driver. Then the head slumped forward onto the steering wheel and stayed there. Elena scanned her surroundings. She'd gone from the urban sprawl of Dallas to the farmland right outside Dainger. She couldn't recall seeing more than three cars in the past ten minutes. An occasional gravel road led off to the side of the highway, but there wasn't a house in sight. Wire strung between stout posts created fences that framed green fields and pastures where horses and cows grazed.

Elena retrieved her cell phone and punched in "911." Her finger was poised over the "send" button when the Buick started a steady drift to the right. Elena leaned on her horn, without any evident effect on the driver. The car slowed as it moved inexorably off the road, onto the shoulder, across a wide patch of grass, rolling to a stop against a fencepost.

Elena closed the distance to the car, pulled onto the shoulder, and hit the button to activate her emergency flashers. When she reached the Buick, the motor was idling but the car was held fast by the stout post in front of it. The driver, an older man, was neatly dressed and clean-shaven. There was no odor of alcohol in the car, although Elena did note a scent that reminded her of Juicy Fruit gum. The man's head rested against the steering wheel that his hands still clutched at the ten and two positions. She felt in his neck for his pulse—strong and steady. He was breathing rapidly but seemed to have no problem with air exchange.

She did a quick once-over of the car's contents. An overnight bag rested on the passenger-side seat. A larger suitcase and a suit hanger bag lay across the back seat. She sniffed at the travel cup that rested in the console on the driver's side—coffee.

Elena reached across the unconscious man, jammed the transmission into park, and turned off the ignition key. She backed away from the car and punched the "send" button on her phone.

"Summers County 911. What is your emergency?" Elena had a brief moment of panic. She seemed to recall that cell phone calls to 911 were routed to the nearest city, but was that foolproof? Was this Summers County? She had no idea.

"I just came up on a man who lost consciousness and ran his car off the road. I need EMTs and the police or sheriff or whoever is responsible for this area."

"Is the victim breathing? Does he appear to be injured? Is he bleeding?"

"He's breathing and has a strong pulse. There's no evidence of an injury. But we need medical attention here."

"What's your location?"

"I'm not sure. I'm new here. I . . . I know I'm about an hour or so out of Dallas, going north toward Dainger." Elena looked around her. What was the number of this highway? "I'm pretty sure I'm on highway 287."

"Are there any billboards there? Mile markers?"

Elena turned a full circle. "None that I see."

There was a brief pause. "That's all right. The units are rolling now, going south on 287. Turn on your flashers. They'll find you."

"Please, can you get some help here as quickly as possible?"

Elena heard radio chatter in the background. "They're on their way. Stay with the victim. Cover him to keep him warm. Don't move him."

"I know what to do. I'm a doctor. Get those EMTs here ASAP."

"Don't—"

Elena ended the call and turned back to the man, who didn't appear to have moved since she discovered him. The fruity scent was stronger now, and his breathing was faster than before. Diagnoses ran through her head at lightning speed until one clicked: diabetic ketoacidosis. Blood sugar through the roof, no insulin to help burn it, so he was metabolizing his own body fat and the by-products were poisoning him.

She grabbed the man's overnight bag and opened it on the car's left front fender. Clothes, a shaving kit, but no medications. If this man was a diabetic, where was his insulin?

As Elena replaced the overnight bag, she saw something she'd missed earlier: a cord ran from the console's cigarette lighter into the back seat to a travel mini-fridge on the floor behind the driver. Of course. A diabetic would travel with insulin, but insulin required refrigeration.

She opened the refrigerator. Bingo! Insulin syringes and needles, packets of cotton wipes, and two bottles labeled "Insulin, NPH." Good for him, bad for her. The man was on a regimen that only required insulin once or twice a day, so he carried a long-acting preparation. What he needed right now was insulin that would be effective in minutes, not hours. And every minute of delay meant the death of more brain cells. She could give him some of the long-acting preparation, but that, plus the proper treatment later, would probably send him into hypoglycemic shock, also carrying the potential for brain damage.

The sound of a siren in the distance saved Elena from a difficult decision. The MICU—the mobile intensive care unit that had replaced the "ambulance" of prior years—would have a glucometer to give a rough reading of blood sugar, and a supply of rapid-acting insulin.

The first vehicle on the scene was a white SUV with black trim. Its light bar spit out rays of red and blue, and its siren was loud enough to make Elena cover her ears. The SUV made a U-turn across the road's grassy median and came to a stop behind Elena's Ford. Two men in tan uniforms emerged. The younger of the two opened the vehicle's trunk, pulled out some flares, and hustled down the road. An older man climbed out of the driver's side. The sun glinted on the badge pinned to his shirt. He adjusted his sunglasses, hitched up his gun belt, and made his way quickly toward Elena.

The lawman touched the brim of his straw Stetson. "Ma'am, I'm Sheriff J. C. Dunaway. The medics are about a minute behind me. What do we have here?"

"I was following this car when it started weaving. Then the driver collapsed onto the wheel, and the car veered off the road. I believe the man is a diabetic who didn't take his insulin this morning, and now he's in a coma from high blood sugar."

Dunaway bent through the open door of the Buick and scanned the interior. He touched the driver's neck lightly with two fingers. Without moving the man's head, he lifted the eyelids and checked the pupils, then ran his hand lightly over the driver's scalp.

The sheriff straightened up and turned back to Elena. "We'll let the medics sort it out." He cupped a hand to his ear. "I think I hear them coming right now. I'll need a statement from you for my report. I can get it here, but it would be a lot easier if you came to my office and dictated it. Were you headed into Dainger?"

"Yes." She extended her hand. "Dr. Elena Gardner. I'm going into practice with Cathy Sewell."

Dunaway removed his hat and shook her hand. "Doctor, I'm pleased to meet you. Cathy—I mean, Dr. Sewell—told me you were coming. I guess I shouldn't have been trying to play doctor when a real one was already here."

"That's—"

Elena realized Sheriff Dunaway wasn't going to hear her next words over the commotion from the whoopers of the arriving vehicles. First came a fire engine. It followed the tracks Dunaway had made across the median, coming to rest behind the accident scene to form a much more effective roadblock than the flares the deputy had placed. It was followed by a bright red MICU that skidded to a stop beside the stalled Buick. Two men in tan coveralls spilled out. The man on the passenger side opened the double back doors of the vehicle and brought out an emergency kit. Elena recognized it as the twin of the ones she'd seen in Dallas MICUs.

The driver hurried up to Dunaway. "What's up, Sheriff?"

"I'll let the doctor here tell you. Dr. Elena Gardner, this is Eric Burson, one of our EMTs."

Eric nodded, obviously impatient to get to work. "What do we have here?"

Elena summarized her findings and suspicions in a few terse sentences.

Eric called out to the other EMT, "Perry, he may be a diabetic. You get his vitals. I'll check his blood sugar. Let's get an IV going."

"What can I do to help?" Elena asked.

"Just let us do our job," Eric threw over his shoulder. "I'll call you if I need you."

Hmmm. Not a very auspicious welcome to the medical community.
Oh, well, at least I won't be blamed if something bad happens to this patient.

"D
octor, I think that ought to do it." Sheriff Dunaway rose from his desk and offered his hand. "I'll give you a call if we need anything more. And thanks for stopping to help that man. I know a lot of people would just pass on by. Like in the story of the good Samaritan."

Elena decided to ignore the Bible reference. Those days were behind her. She paused at the door to the sheriff's office. "I think I'd like to go by the hospital and see how that patient's doing. I'm afraid I've only been there once. Can you give me directions?"

"I can do better than that," Dunaway said. He called to the deputy who sat at the front desk. "Frank?"

The deputy turned. "Yes, sir?"

"Would you get in one of the cruisers and lead Dr. Gardner over to the hospital? She's new in town, and I don't want her to get lost on her first day."

Frank rose from his desk, and when he turned toward them Elena felt her knees buckle. At first glance, he was the spitting image of her late husband. Frank's smile displayed gleaming teeth in a face that belonged on a movie star. He was about her age, trim and fit, with dark hair and sparkling gray eyes.

He stuck out his hand. "Frank Perrin, doctor. Pleasure to meet you."

"Well, I'll leave you in Frank's hands." Dunaway turned back to his office.

Frank gestured toward the door. "The hospital's only a few blocks from here. I can lead you there, if you'd like." He took a couple of steps, then turned back. "Better still, why don't I take you there? I can wait for you and bring you back here for your car when you're through." He glanced at the sheriff' s open door and lowered his voice. "I could even buy you a cup of coffee if you'll let me."

Elena's thoughts churned like water in a fishpond at feeding time. She wanted to see "her" patient at the hospital. She should move her things into the Kennedys' house. She ought to call Cathy and check in with her. But it would be so very nice to put herself in the hands of this man for a little while. Even though she knew he wasn't Mark, being near someone who was so like her late husband, even for a bit, was appealing. "I . . . I think that would be nice."

She'd never ridden in a police car before. Elena took note of the radio, the scanner, the radar unit. She flinched when she saw the shotgun mounted behind her, in front of a mesh screen that separated the driver's compartment from the back seat. She fastened her seatbelt, almost afraid to touch anything in the process.

Frank laughed. "Pretty impressive, isn't it? I guess that's one reason little boys want to grow up to be policemen—so they can play with all these toys." He clipped his seatbelt. "Want me to turn on the lights and siren for the ride to the hospital?"

Elena had her mouth open to reply when she realized he was kidding. "I appreciate your doing this."

Frank waved it off. "No problem. Things are pretty quiet, and this gets me away from that desk for a while. Besides—"

He nodded toward the microphone clipped to the shoulder loop of his immaculate tan uniform. "If they need me, they'll call."

At the hospital, Frank wheeled into the Emergency Room parking area and left the unit in a slot marked "Police." He stopped at the ER admissions desk and was told that the emergency patient, whose name was John Daniels, was in room three with Dr. Baker.

"I'll only be a minute," Elena said. "I want to see if the patient's going to be okay, and introduce myself to the doctor taking care of him."

Frank pointed to a door. "I'll hang out in the break room there. See you soon."

Elena tapped on the half-open door of room three and eased inside. Mr. Daniels lay on a gurney with a woman in hospital scrubs at his side, adjusting the flow of an IV. A middle-aged man in a white coat worn over slacks and a sport shirt stood to the side, scanning what Elena took to be an ER chart.

She cleared her throat. "Dr. Baker?"

The man looked up but said nothing.

"I'm Dr. Elena Gardner. I'll be going into practice with Dr. Sewell. I'm the one who found Mr. Daniels right after he lost consciousness. I wanted to introduce myself and see how he's doing."

Baker's smile was minimal but real. He offered his hand. "Evan Baker. Nice to meet you. The EMTs checked Mr. Daniels's blood sugar with a glucometer and started insulin. Even at that, his sugar was through the roof and his electrolytes were totally out of whack when he arrived in the ER. Typical diabetic ketoacidosis. We're bringing him under control, and I think he'll come out of it fine."

"Good."

"I understand you made the diagnosis on the spot, just from Kussmaul respiration and the smell of ketones on his breath."

"I . . . Yes, that was my first impression."

"Well, nice pick-up. I look forward to working with you."

Elena left the treatment room feeling somewhat better. At least one doctor in town seemed to be on her side. Better than the reception she had received from Eric, the EMT. And, speak of the devil . . .

"Doctor, come to make sure we didn't foul up with your patient?"

"Eric, I don't know what I did to get off on the wrong foot with you, but whatever it was, I'm sorry. And, to answer your question, I dropped by to make sure I didn't miss something at the accident scene. As it turned out, my evaluation was correct, and your treatment was good. Mr. Daniels is going to be fine."

Eric's reply was a sniff. He turned on his heel and headed out the door, where his MICU idled in the intake bay.

Okay, I'm one for two. I'm not sure what Eric's problem is, but obviously he's got something against doctors. Or maybe it's just me.

She found Frank in the break room, deep in conversation with one of the male nurses about the relative merits of the Dallas Cowboys and the Houston Texans. "Ready to go?" he said.

"Yes, thanks."

Elena climbed into the sheriff's SUV with a bit less apprehension this time. Actually, it felt kind of cool riding up here. And she had to admit she enjoyed having a handsome man beside her. It gave her a thrill—a guilty thrill, but nevertheless it was a sensation she hadn't felt in a long time. Part of her wondered what she was doing. Part of her said, "Relax. Enjoy."

"Are you going to have enough room here?" Dora Kennedy reminded Elena of a bellman in a nice hotel, anxious that the guest would find the accommodations comfortable.

Elena stood in the doorway and surveyed the room that would be her home for a while. It wasn't large, but the overall effect was cozy. A double bed was butted headfirst against the near wall to her right, with a double dresser and bookcase taking most of the wall opposite. The room's only window was at the far end of the left wall, with an easy chair, reading lamp, and end table nearer the hall on that side. The right-hand wall contained two doors, with a picture hanging between them. The door closest to the hallway was closed. The open door, nearest the outside wall, afforded a glimpse of a cozy bathroom.

Elena wrestled a large suitcase onto the double bed. "I'm sure it'll be fine. Thanks so much for opening your home to me."

"Not at all." Dora pointed to the open door. "You have your own private bath. Linens are in the cabinet."

"Very nice."

"This was Will's room. Since he left, we've used it for guests." She opened the closed door and shoved aside several hangers draped with coats. "Here's your closet. It doesn't get much use, so I'm afraid it's accumulated some things we don't want to throw away but don't use much, either."

Elena took a handful of empty hangers and filled them with blouses, slacks, and dresses. "I'm sure there's still plenty of room. Besides, I hope to find a place of my own soon."

She reached into the closet to deposit her clothes and bumped a long, khaki-colored canvas case on the top shelf. Elena started to move it, then jumped back as though she'd felt a snake. "Oh!"

"What's the matter, dear?"

"There's a gun up here. That's not exactly the kind of thing I expected to find in a preacher's home."

"That's Will's shotgun," Dora said. "He and his friends used to go dove hunting in the fall. When he got married, Cathy told him he couldn't keep the gun in their house. Matthew's checked it, and I can assure you it's not loaded. Matter of fact, there aren't even any shells in the house. So it's perfectly safe." She reached out her hand toward the shelf. "Would you like me to move it?"

"No, no. It'll be fine there."

As Elena unpacked, Dora kept up a running commentary on the town. There was not a shred of what might be termed "gossip" in the whole conversation, but Elena got the impression Dora and Matthew Kennedy were tuned in on most of the comings and goings in the community.

Elena moved to the bathroom and started to stow her makeup. "I had quite an introduction to Dainger," she called over her shoulder. "Even got to meet a sheriff." She sketched out the highway incident for Dora. "The lead EMT wasn't too pleasant, though."

"That would be Eric. Poor man. Lost his wife, and he's blamed doctors for it ever since. But Cathy tells us he's good at what he does, so she ignores his jabs."

"Well, there are always a few people like that around." Elena closed the last suitcase and shoved it into the back of the closet." The good news is that I sort of made friends with the sheriff and one of his deputies."

"Oh, J. C. Dunaway's a fine Christian man. Our police force is good, mind you, but if I had a real problem, I'd trust it to J. C. in a heartbeat."

"He was very nice. Even had one of his deputies drive me to the hospital so I wouldn't get lost. We had lunch afterward."

"Which deputy?" Dora asked.

"Frank Perrin. Do you know him?"

In the short time she'd been around her, Elena had never heard Dora Kennedy say anything bad about anyone. The preacher's wife kept that record intact by saying, "Yes, I know Frank." But the expression on her face was what Elena imagined Dora would display if she found two-day-old roadkill in her driveway.

Cathy laid down her book and reached for the phone. Who could be calling her at home on Saturday afternoon? She hoped it wasn't the hospital. Wasn't Dr. Brown on call? Then she saw the caller ID.

"Elena. What's up?"

"I just got into town and wanted to check in with you."

"Glad you made it. Where are you?"

"I'm at the Kennedys' now, but I started out at the sheriff's office."

A myriad of thoughts, all of them bad, flashed through Cathy's head. "Is there a problem? Do you need a lawyer? Will and I can be there in ten minutes. Let me call Sheriff Dunaway. He knows me. We—"

"Take it easy. I saw the driver in front of me slump over the wheel of his car, and I called it in. The sheriff asked me to stop by his office for a formal statement. Then he had one of his deputies drive me to the hospital so I could check on the patient."

"Whew. I had visions of something bad happening," Cathy said. "So you've been at the hospital all this time?"

"Not really. After I finished looking in on the patient— he's a diabetic who went into a coma, and Dr. Baker's taking care of him—anyway, the deputy asked if he could buy me a hamburger. We sat at the Dairy Queen for half an hour. Then he took me back to get my car and led me to the Kennedy house."

"I know most of the deputies here in town," Cathy said. "Which one were you with?"

"Frank Perrin. Know him?"

Cathy took her time answering. "Yes, I know him." She'd been wrong. Something bad had happened to Elena. Her new associate just didn't know it yet.