Authors: Lisa Scottoline
Some not even dead, but still very much alive.
Chapter Forty-six
Jill bustled past the eye chart toward the lab, on the run. She still hadn’t received Rahul’s bloodwork and knew that something had gone wrong. She felt exhausted after a sleepless night, plus she’d had to be at the phone store early to buy a new BlackBerry and had stood in line forever. She’d listened to Abby’s message on the way in, but it hadn’t mentioned her cat.
Jill opened the door to the small lab, where their phlebotomist, Selena Grant, looked up from a full tray of blood samples, each standing like a soldier in its wire separator, with its rubber stopper labeled in her characteristically neat print. “Hi, Selena, did we get results for Rahul Choudhury? They should’ve been in yesterday, but I got no email.”
“Choudhury?” Selena blinked, her dark eyes worried under a stiff curl of black bangs. She was small and slim, dwarfed in boxy scrubs covered with kitten faces, because she was a cat fancier. “I don’t remember that name.”
“He’s a baby, a one-year-old? I ordered a CBC with differential. Mom is waiting for me in Exam Room B. He was in on Saturday.”
“Oh no. I remember the baby, now.” Selena’s face fell into long, gaunt lines, and she looked much older than her forty years. “I messed up on Saturday. I forgot to send it in. I realized it late Monday, and I was going to tell you, then I forgot that, too. I’m so sorry, Jill.”
“That’s not like you,” Jill said, surprised. “You’re our rock.”
“I know, but my mother, they moved her to hospice.” Selena’s eyes filmed. “They called me Saturday, and I left work, upset. I forgot everything.” Her hand went to her cheek, pressed flat against it. “I’m at such a loss, I can’t keep track of anything. They say she has only a week or so.”
“I’m so sorry.” Jill felt terrible for her and touched her shoulder. She had known that Selena’s mother had stomach cancer, but not that she’d declined so quickly. “Is there anything I can do?”
“Pray.”
“I will, but you don’t have to be here. Go and be with her. Take the time off.”
“I can’t.” Selena sighed, shaking her head. “I’m out of vacation days and all my other leave. I used it up, on her. Sheryl says I have to stay until Monday, when Linda comes back.”
Jill knew that could be too late. She remembered the last week she’d spent with her own mother. It had been hell, and she still wouldn’t have traded it for anything. “No, you don’t have to wait until then. Go, now. You’re finished for the week.”
“For real?” Selena looked up, hopeful.
“Yes, go.” Jill turned to the cabinet, found a cube of Post-its and a pen, and on the top paper, wrote LAB CLOSED. “I’ll deal with Sheryl when she gets back from lunch.”
“Thanks so much, Jill. But what about your patient?” Selena grabbed her bag, and Jill picked up a phlebotomy kit.
“I’ll take his blood. I’ve kept up my qualifications. We can all collect our own samples or send patients to LabCorp for a week.”
“The docs will take their own blood?” Selena’s penciled eyebrows flew upward.
“Yes, we’re smarter than we look. Come on, let’s go.” Jill followed Selena out of the lab, stuck the Post-it on the door, and took off down the hall with the kit.
“Thanks again, Jill. So much.” Selena waved good-bye, and Jill opened the door to Exam Room B, went inside, and set the phlebotomy kit on the counter. She faced Padma and Rahul, who sat on the examining table in his diaper, playing with a set of Acura keys.
“Padma, I’m sorry, but we lost Rahul’s blood sample.” Jill hated watching Padma’s face fall, and there was new tightness around her lips. “That’s why we didn’t get his results yet. I’m so sorry. I’ll take another sample myself, after I examine him.”
“Oh no.” Padma ran a hand through her glossy hair, stopping at the ponytail. She looked more stressed than usual, and her sweater was unusually wrinkled, for her. “I hate to do that to him again. He cried so much.”
“I know, and I’m very, very sorry.” Jill slid her stethoscope from around her neck and went over to Rahul. He’d been weighed by the nurse, and he’d lost another half a pound. Jill thought his
gestalt
wasn’t any better, even after three days on amoxicillin. “How is your mother? Any better?”
“Yes, thanks. My brother thinks taking a blood test is overkill for an ear infection.”
“I know, but I think it’s important. Hey, Rahul, what do you say there?” Jill tickled his bare tummy, which felt warm to the touch, and he didn’t smile as much as before, though another tooth nugget was popping through his pale pink gums. “Two teeth now? Good for you, big boy!”
“Gsmssm,” Rahul said, producing bubbles, so at least he wasn’t dehydrated.
“Let’s get a listen.” Jill warmed the stethoscope on her palm and placed it against the baby’s tiny chest, then put it in her ears and listened to the stepped-up pace of his heart, then the noises of the infection in his chest. His temperature was 101, and he’d had it for too long.
“My nephew, he gets them all the time, that’s why they had tubes put in.” Padma tucked a glossy strand of hair into her ponytail. “You’re positive that this is necessary, to take blood from him, twice now?”
“I’m sorry, but I do.” Jill looped the stethoscope around her neck, then felt his glands at his throat, which were still swollen. She looked into his ears, nose, and throat, and it was still purulent. Most pediatricians would say that Rahul was failing the amoxicillin, but Jill hated that jargon. The medicine was failing the baby, not the other way around. “He’s as sick as he was Saturday. I’d like to switch him to another antibiotic and see if that helps.”
“Whatever you think.”
“We’ll put him on Augmentin then.” Jill lay him down and palpated his belly, spleen, and liver, then sat him up and felt the glands under his armpits, all of which were swollen.
“My sister-in-law was over to dinner last night, and she said we should just get the tubes, too.”
“Let’s discuss it after we get the results, okay? I’ll order them stat, so we’ll know tomorrow.” Jill checked his skin, and his patch of eczema was the same, no worse. “Is he drinking and eating?”
“Yes, but not so much.”
“Sleeping?” Jill checked inside his diaper, which was dry, so she sat him up, and Padma took over, steadying him.
“Same as before.”
“Let me write that script.” Jill went back to the laptop, logged into Epic with her password, and found Rahul’s file, then printed out a script for Augmentin and handed it to Padma, who slid it into her back pocket. “Okay, I’ll need to take some blood. This time, I swear it won’t go missing.” She went to the kit and prepared a syringe. “Would you hold him or would you prefer that I get a nurse?”
“No, I’ll hold him.” Padma picked up the gurgling Rahul, cuddling him protectively, and he shook the keys. “He cried so hard, last time. I hate to do it all over again, for no reason.”
“I understand, but we’re doing it for a reason. It’s good to be thorough.” Jill knew that Padma was trying to do what was right for her child. “I’m trying to get to the cause of these infections.”
“They all get ear infections, some more than others, isn’t that so?”
“Yes, but it’s the frequency of his that concerns me, and don’t forget that he had pneumonia.”
“My nephew got
eight
ear infections his first year. He was on amoxicillin all the time. They called it his bubble-gum drink.”
“Your nephew isn’t Rahul. We know that it’s an ear infection, but it’s always important to ask, what’s behind this? We can’t stop at the short answer.”
Padma shook her head, holding the baby. “I just hate to do this to him again.”
“Isn’t it better to be on the safe side? We don’t want to call off the search just because we have an answer, if it’s not the right answer.” Jill met Padma’s dark eyes and could see that she was getting through to her. “We call that diagnosis momentum, which is a fancy way of saying that once you arrive at a possibility for a diagnosis, it sticks, when it shouldn’t. Okay?”
“Okay,” Padma answered, satisfied. “I know my family influences me, a little.”
“That’s okay, that’s what family’s for. Hold Rahul, and I’ll make this fast.” Jill wiped antiseptic on Rahul’s arm, tied a tourniquet, attached a butterfly needle to the syringe for use with babies, and inserted it into a vein.
“WAAAAHHH!”
“I’m so sorry, Rahul.” Jill pulled back the plunger, collected the blood, then loosened the tourniquet, extracted the needle, and put a cotton gauze on the wound. “Good boy!”
“It’s all right, honey.” Padma held Rahul close as he cried.
“Padma, well done, and thank you for assisting.” Jill stuck a stopper on the test tube, labeled the sample, and set it down, then took a piece of adhesive tape and put it over the gauze on his arm. “I’ll see you back here tomorrow, and I’ll have his results. When can you come in?”
“The morning is best, while his brothers are at school.” Padma wiped Rahul’s tear-stained cheeks, and his little chest heaved a baby sob.
“Poor little guy.” Jill touched his cheek, wet with tears. “Okay, see you at nine. I’ll tell Donna you have an appointment. Thanks so much.”
“Thank you.” Padma smiled.
“See you tomorrow.” Jill left the room and went down the hall to the appointment desk, where Donna was just hanging up the phone, pushing back a puff of dark hair. “Donna, can you please put Rahul Choudhury in at nine tomorrow? I’ll come in specially to see him.”
“You mean the cutest baby ever?” Donna hit a few keys on the computer. “Of course.”
“Thanks, that’s my girl.” Jill smiled, and Sheryl came striding over from the office. The staff must have seen that Selena had left, because they were all sneaking glances from their computers, files, and phones, waiting to see what would happen between Jill and Sheryl.
“Jill, did you really close the lab?” Sheryl asked, her voice low, so that the full waiting room couldn’t hear.
“Yes.” Jill matched her soft tone. She didn’t want to make a scene, and she’d never get along with Sheryl if she embarrassed her. “Selena’s mother is very ill, and they should be together. I know you must feel the same way.”
“I do, but we have a business to run.”
“I’m not trying to interfere with that. I can take blood, and so can any doc who’s kept up his qualifications. Let us do some work for a change, eh?” Jill smiled, and so did the staff.
“I’ll take this up with John.” Sheryl edged backward, frowning. Donna studied her desk, hiding her smile, and so did everybody else.
“Great, thanks.” Jill turned on her heel, went back down the hall, slid the file of the next patient from the holder, and went into Exam Room A. It took only two colds, another ear infection, and a broken toe for John Gilbert, the senior partner, to find her between patients. He was a preppy internist in his fifties, in horn-rimmed glasses, a red-and-blue rep tie, and a pressed lab coat with his name embroidered on the breast pocket. He took her aside in front of his office.
“Jill, can I see you inside, a sec? This’ll be quick.” John opened his door, and Jill followed him into his office. “Jill, what happened with Selena?”
“Her mom’s in hospice, and I sent her home. We’re doctors, and if we don’t have compassion for suffering, then who does?”
“This isn’t about compassion.” John frowned. “Sheryl handles personnel matters, not the docs.”
“I know, but Selena is so distracted that she lost a sample for one of my patients. Do you want to make Sheryl happy or do you want to get sued?”
“Good point, but I’m not about to take blood myself. I haven’t taken blood in nine years, I don’t have time. None of us do, you know that.”
“Then send your patients to LabCorp. It’s not far.”
“They’re not accustomed to that inconvenience.”
“It’s the suburbs, John, nothing’s
that
inconvenient. They probably have drive-through blood.” Jill thought of Rahul. “Listen, please, help me get my new bloodwork stat, would you? You have privileges at Phoenixville, don’t you?”
“It’s not that easy.”
“It has to be. I’m worried about this patient, and with babies, you don’t get the margins that you do with adults. They go downhill fast.”
“Enough, okay.” John put up a hand. “Tell Donna to call Charlotte. She’ll make it happen.”
“Thanks. Gotta go.” Jill hurried out to the door, with no time to reflect on whether she’d pissed off her boss. She had a slew of patients, and she had to be out of work on time tonight.
To go see about a corgi puppy.
Chapter Forty-Seven
Jill stopped on the main drag of Hoboken, where low-rise apartment buildings and older brick townhouses stood with storefront bodegas, gourmet coffee shops, Greek restaurants, and hip boutiques. A constant stream of people filled the sidewalks, heading home from work or bubbling up from the PATH station, like a people geyser.
“You have reached your destination,” said her GPS.
Jill spotted a parking space, slid into it, and cut the ignition. She’d never pretended to be anybody else before, and she wondered how William had done it, maintaining two identities at once. She retrieved the Phillies cap and popped it on. Oddly, it helped her play her part, like a costume for a role. Jill got out of the car and spotted Nina D’Orive across the street. She was a pretty, petite blonde in pink sweats and she was standing with her husband, in running clothes. A fawn-colored corgi puppy was tugging on his sneaker laces.
“Hello, Nina!” Jill waved, thinking of a way to get Nina alone. She crossed the street and extended a hand. “I’m Katie Feehan, from Facebook.”
“Hiya!” Nina shook her hand, flashing a pretty smile. “This is Martin, my husband.”
“Thanks for meeting me.” Jill shook his hand. “I know I said I’d bring the boys, but I had second thoughts. I want to decide about the dog on my own, then make it a surprise.”
“Oh, too bad.” Nina glanced at her husband. “Martin wanted to meet them. He’s all about kids.”
Martin grinned. “I want my own baseball team. Go Mets!”
“Go Yanks!” Nina said.
“Go Phils!” Jill chimed in, and they all laughed.
Nina said, “Sorry we have to meet here, on the street. Martin didn’t think we should meet you at home, since we don’t really know each other.”