Healer (35 page)

Claire closes the chart, disappointed. She had hoped for a definitive answer, some solace for Miguela, if there could be any comfort in pinning a confirmed diagnosis to her daughter’s cause of death. Claire opens the folder one more time and flips to the back of the brass-tabbed pages looking for the lab results. Nothing. Which meant nothing. Esperanza might have walked out the second someone came in the room waving a needle at her. But the fact that Dan had been checking a pregnancy test was enough. The diagnosis of toxemia fit. At least she might convince Miguela her daughter had not been murdered or part of a sex ring.

She tries to imagine Esperanza traveling by bus on rutted dirt roads through the mountains of Nicaragua, pregnant and sick, her illness escalating toward seizures and inevitable death if she couldn’t be delivered. If she had stayed here, she and her baby would most likely be alive.

She waits until Addison and Jory are upstairs to talk to Miguela, tries to ease into it by asking her to repeat what she remembers again, anything that might explain more than Claire found in the single page of Esperanza’s chart. Had she had a fever, any rash, had the baby still been moving? Did any doctor see her before she died? Was she
sure
Esperanza was pregnant—Dan had not been certain only three months earlier.

Miguela seems worn out by the questions. “The doctor in Jalapa said it was too late.”

“I think, from everything you’ve told me, I think Esperanza had a complication from her pregnancy. It’s called toxemia. Without being in a hospital, without a C-section—
cesárea,
you understand?—without that there is no way to save the mother’s life.”

Miguela’s face looks like Claire is pronouncing Esperanza’s death for the first time. She is struggling against such a final conclusion, Claire can see it. As if she’s come too far tracking her daughter’s death to accept it as an unpreventable consequence of nature—needs to identify some perpetrator other than God and poverty. “But what about this house? She told me she was there many weeks.”

“The address in her chart was for the orchard. Toxemia makes the brain swell—I think Esperanza might have been confused. Maybe the house was the orchard office. Or the clinic.”

Miguela is quiet for a long time. Finally Claire asks her if she wants to be alone.

She puts her hand on Claire’s sleeve. It is the first time, Claire realizes, that Miguela has ever touched her. “
Doctora…
Please. I need to see myself. I want to go to the clinic.”

Claire is used to the clinic on Sundays, a quiet peace that helps her work or study. A sense of time and disease arrested. She locks the door behind them, knowing that the lights might attract any passing patient with a complaint. Miguela seems hushed, intimidated by the vacancy of a place usually filled with waiting patients and the noise of illness and injury. Claire leads her through the swinging gate into the records stacks. Even for so small a clinic they are impressive, with floor-to-ceiling shelves of coded charts on two rolling metal frames. She walks down the row of
R
s until she finds Esperanza’s, slips it out and puts it on Anita’s desk.

Miguela seems hesitant to open it. Claire pulls out a rolling stool and sits beside her. “It’s okay. She was your daughter.” Miguela runs her hand over the smooth manila cardboard of the chart. Claire watches
her, sees her take in a breath and sit up straighter, then, at last, lift the front cover open. Claire asks her, “Can you read it?”

Miguela nods but stares at Dan’s note without moving her eyes, maybe just absorbing the fact that these words are the closest she will ever come to her daughter’s life in this country. After a few minutes she turns the single page, as Claire had done, looking for more, scanning the typed facts of age and address, the country of origin. Then she pushes the chart away and stands up. “Thank you. You are kind to bring me here when everything is closed.” Claire picks up the chart and walks back along the row of
R
s to find its place. She hears Miguela start to leave the waiting room. But then Miguela takes a step back toward Claire and asks, “Why would they not use her whole name?”

“What?”

“Why did they only use part of her name?”

Claire stops, turns the chart sideways to read Esperanza’s name in bold type along the edge of the front flap. She looks at Miguela, puzzled. “Esperanza Ruiz. Isn’t that… Wasn’t that her name?”

“Esperanza De Estrella Ruiz. Her father’s name was De Estrella.”

“Her father’s name was De Estrella?”

Claire knows it is the common custom in Latin America to use both parents’ names—often enough it has caused confusion with their medical records. “Did she go by both names after she left Nicaragua? Do you know?”

Miguela shakes her head. “Will you look? Please?”

Claire pushes one rolling rack down the length of its tracks and stands on a footstool to reach the
E
s. She flips through them, pressing her thumb against the edge of each chart, saying the names under her breath: “Escada, Escondido, Estonce, Estrella.” There are multiple Estrellas. None is Esperanza. She steps down. “She’s not there. Probably she went by Ruiz in the clinic.”

Miguela takes a hesitant step forward, then walks up to the shelves and scans the letters lining the protruding flaps. She is ahead of the
E
s, reaches up to push a few charts forward and pulls one slender volume out of the rack.
ESPERANZA DE ESTRELLA RUIZ.
It had been filed under the letter
D.

The date on it is late November, less than two months later. It’s no thicker than the other chart; the two combined are only five pages. It is the contrasts between them rather than the similarities that are disturbing, the numbers marching in a column down the last sheet that refute the diagnosis she was so sure of half an hour ago. Some of the labs could be consistent with toxemia—the elevated liver enzymes, the anemia, the low platelet count—
if
they had been discovered late in Esperanza’s pregnancy.
If
Esperanza had been pregnant. Her pregnancy test result in the laboratory section is negative. Claire looks at it twice, even runs her finger across the page from the chemical term, Beta HCG, to the negligible measured quantity. Dan’s note on the lined progress paper consists of a single word scribbled during Esperanza’s follow-up visit,
hepatotoxicity,
underlined and followed by a bold question mark.

“She wasn’t pregnant. Something was wrong with her liver.
Hígado.
” Claire translates when she sees Miguela’s confusion. “It can make the abdomen fill up with fluid—enough to make a woman look pregnant.”

Miguela seems almost afraid to open this chart, touches it once and then moves her hand away. “Why? Why would she have this?”

Claire starts to list the possibilities—viruses and cancers and alcohol, toxins and Tylenol, sclerosing ducts and impacted stones—but all the medical words sound coldly clinical, untranslatable even if she knew the Spanish words. “There’s just no way to know from these labs.” She hates the finality she hears in her voice, relaxes her posture so that her face is nearer Miguela’s. “I’m sorry. I’m so sorry.”

Miguela covers her eyes with one hand; the other is pressed into her abdomen like her body might fly apart if she let go. Claire can’t tell if she’s crying. “Can I get you anything? Some tea?” she asks.

Miguela looks at her like she hasn’t understood this, either. “It’s because of the medicines they gave her, isn’t it?”

Claire flicks on the small desk lamp beside Anita’s computer. “Miguela, there’s nothing in her chart that indicates she was given any kind of medicine. Dan’s note doesn’t…”

“Other people lived in the house with her. She told me. If we could find them they would remember.”

Claire studies her face for a minute, notices the shadowy hollows underneath her eyes, the grim set of her mouth. Every smile Miguela has shared in the last month seems like a sad, strained pretense now. She lowers her voice, trying to hide her frustration. “Her address was the orchard. Walker’s Orchards. Where
you
worked. She was confused. You said that. Remember?”

“Yes. She worked at the orchard. But then someone took her to this other place, where they hurt her.”

Claire doesn’t know what to say anymore. Logic, reason, any rational counter is doomed because it will always end with the same tragic fact of Esperanza’s young death. She opens the chart again, ready to show Miguela anything more measurable than her grief-tainted memory. “These numbers, here: Esperanza’s INR and her pro-time. They measure a protein made in the liver that helps blood clot. They were too high. It means her liver was very sick. That is why she had bruises.”

Miguela looks bewildered; maybe Claire’s explanation has been too complicated. But something in Miguela’s unashamed, questioning gaze cuts to the mother in Claire, begs her to admit she would do the same—push and push until she found an answer. “Let’s go home. We’ll eat something and we’ll talk about everything you remember. Maybe we can find someone in Hallum who remembers her. Maybe I can talk to Dr. Zelaya.” She opens the back flap of both charts side by side on the desk, unclasps the brass tabs that hold the pages together.

Miguela watches her intently, possessively. “Why are you taking them apart?”

“To combine them, so everything will be together.” Claire stacks the pages of Esperanza Ruiz and Esperanza De Estrella Ruiz into their new order, thinking it all through one more time: a young girl living in a house where someone was giving her medicine or drugs, using needles on her. How many thousands of immigrants ended up trafficked for sex, or addicted through choice or coercion? If that had been Jory’s irremediable fate she might not even want to know about it.

She aligns the punched holes and slides the pages onto the opened brass flanges. But now the front page, the one with the factual demographics in Esperanza’s mistaken name, is wrong—should, in fact, be
torn up, Claire decides. She lifts it off the tabs and the two pages with their two different names are side by side in front of her. And for the first time she sees that the name is not the only difference in the typed data that Anita must have taken from Esperanza at this very desk.

Miguela has obviously noticed her reaction. Claire feels caught, wishes she had just left the charts as they were.

“What is it?” Miguela asks.

Claire hesitates, then turns on Anita’s computer and opens the patient database they keep, little more than an Excel spreadsheet; scrolling through the
R
s and then through the
D
s she finds the same duplication—two Esperanzas. With two different addresses.

Miguela sweeps the pages into her lap, scanning the boxes of information. “The addresses are different. She is in Wenatchee here.”

Claire sees the change in Miguela’s face, sees her back away from releasing all of this—almost relieved that her obsessive hunt can résumé and delay the insurmountable fact of Esperanza’s death. “Miguela, there could be another reason.” Claire starts talking, tempted to take the pages away from her. “I’ll ask Anita on Monday. She might remember something.”

“Call the number.”

For a moment Claire thinks that Miguela wants her to call Anita right now. “Call?”

Miguela picks up the desk phone and holds it out to Claire. “Please. Call the number in Wenatchee.”

Claire dials the number and waits through six rings, about to hang up when a woman answers. She listens for a moment and clicks the receiver down.

“What is it?” Miguela asks.

Claire shakes her head. “It was some company. A business.” She brushes her hand across the page, as if the numbers might magically appear more clearly or change altogether into an obvious solution she should have put together from the start. At least, she thinks, it’s unlikely a brothel or drug house would hire such politely professional office staff. “Maybe I dialed wrong. Or the phone number could have changed since Esperanza lived there.”

She dials the number once more; this time the woman answers after only three rings. Claire’s finger hovers over the button ready to disconnect the call; she’s crazily embarrassed about disturbing this complete stranger again. But now, when the woman answers and states the name of the business, Claire recognizes it.

She hangs up and walks back to the record shelves, this time hunting through the
A
s until she finds Rubén Aguilar’s chart. She already knows the contact phone number and address are out of date, doesn’t bother to compare them to Esperanza’s. She is looking for the single, loose slip of paper she had scribbled his address and new number on, riffling through the pages, shaking the chart upside down with no luck. Miguela is watching her, visibly restraining herself from interrupting. Claire stops to think for a minute, tries to slow her mind down so she can remember.

Miguela reads the name off this other patient’s chart. “Who is this man?”

“I think he was there. At Optimus. I’m sure that’s who answered the phone.…” She stops, remembering at last where she’d put it. She pulls her cell phone out from the clutter of her purse and punches in the first three letters of Rubén’s last name. The same number they have just called pops up in the screen.

She turns to Miguela again. “Tell me. One more time. Tell me what Esperanza said about the house.”

Miguela begins to repeat what she has said before, glimpses of something like a hotel or a boardinghouse, confused with memories of medications and needles and blood, all of it mangled by Esperanza’s illness, by Miguela’s grief, by an imperfect translation between Spanish and English. It’s a senseless history if you listened to it rationally or considered it skeptically, degenerating more every time she tells it. Claire can see that Miguela is distraught.

The computer screen has already gone dark, but jumps to life as soon as Claire touches the mouse. She clicks onto the Internet and types in
Optimus
; a dozen different companies fill the page. Then she refines the search, adding the words
research
and
Wenatchee, Washington.
The screen goes white while the slow clinic connection filters
through to a new list—the top link connects directly to OptimusResearch.com, a blue and white scheme with the words
Optimus Clinical Research
in bold letters, slanting across a broad band of graduated color. Above the company name a man and woman in white coats consult over a clipboard. The man appears studious, handsomely graying with a stethoscope looped around his neck; the woman is blond and smiling. Underneath the logo a string of quotes float by, like banners pulled by a prop plane across a blue sky: