Fallout Page 2

  Chapter Two

  Allison Wright began making mental notes for the patient file. Well-nourished, Caucasian male, appearing to be stated age. She pulled on a fresh set of sterile gloves.

  “Okay,” she said, “take off your shirt.”

  Ricky Scruggs, twenty-five, hunched his shoulders to tighten the pectoral muscles under his tight, black t-shirt and admired himself in the examining room mirror. “I will if you will.”

  Allison cocked her left eyebrow and fixed Scruggs with her stare.

  “Just kidding,” he said quickly.

  Allison considered giving him a lecture on sexism before concluding it would be wasted on a patient who’d begun by asking if he’d get to see a “real” doctor—presumably male. She raised the shirt over Scruggs’s chest and gently lifted the ring piercing his left nipple. Scruggs yelped. She probed the inflamed, scabbed skin. Reddening. Ulceration. Necrosis of the dermis. “You might have come in when it first got infected,” she admonished. “Take it out.”

  Scruggs maneuvered the ring from his nipple. Pus and blood oozed from the puncture holes. Allison spread a paper towel on a box on a counter next to the examination table. Scruggs placed the ring on it.

  Allison cleaned the wound and examined the inflamed area with a magnifying glass. She judged it to be eight centimeters, about twice the size of a fifty-cent piece.

  On any given day, her clinic—a yellow converted Victorian home three blocks from the river—saw a catalogue of the ills that had befallen mankind within a twenty-mile radius of Winston, West Virginia. Snake bites, cut feet, broken arms and ear infections, assorted injuries to workers at the plant, predictable diseases of the aged and dying. When someone in the area needed medical attention, they showed up at the Winston Medical Clinic. Allison enjoyed the variety. Every day was a new problem, a new challenge. And despite having to deal with occasional boors like Ricky Scruggs, every day provided a chance to help people who were hurting and who appreciated her help. It made her feel competent, useful—needed.

  “How long have you had this piercing?”

  “Couple days.”

  “You did it yourself?”

  “Wasn’t hard.”

  Allison cleaned and dressed the wound, scribbled a prescription for flucloxacillin and gave Scruggs half a dozen small tubes of mupirocin, the generic form of Bactroban.

  “Take the pills twice a day and use the ointment until the samples are gone. If it doesn’t clear up in a week, call me.” She decided what she’d write in the case notes in the patient file. Infection—surely caused by a do-it-yourself job with an unsanitary instrument.

  Scruggs pulled on his shirt. “What about the ring?” he asked.

  “Leave the ring out while you heal. The hole will close but if you feel you must, the piercing can be redone. This time, use a licensed professional.”

  Scruggs put the nipple ring in his pocket and left without a thank you.

  Allison sighed. If Scruggs was like a frustrating number of patients, particularly males, he would ignore her orders. The nipple ring would be reinserted as soon as the infection abated.

  Her last appointment of the day was with Katie Gibbs.

  “My God!” she exclaimed when Katie walked into the examination room. “You’ve become a clone of your mother!” Allison forgave herself for the reaction. It really was like looking at a ghost.

  With the exception of what Allison called her “lost years,” Sharon Gibbs had been Allison’s closest friend from grade school until her death, sharing secrets, ambitions and causes. Winston had no Race for the Cure until Allison and Sharon started one. The irony was lost on neither of them when Sharon developed breast cancer. When the end was near, Allison had been there to provide palliative care—and afterwards worked with Josh to create a hospice county program in Sharon’s honor.

  “Hi, Allie.” Katie blushed.

  Allison couldn’t believe how quickly the girl had grown—at least eight inches in the last year. She was definitely at the awkward stage—still a child in many ways but quickly becoming a woman, as evidenced by the baby fat turning to curves.

  “What’s happenin’ with the Kate-ster?” Allison gave her a fist bump.

  “My left leg hurts. Dad wanted me to get it checked out.” She took a folded piece of paper from her pocket. “Also, I need you to sign this health permission form for soccer camp.”

  Allison took the form. “Camp Kanawha. I met my first boyfriend there because I had the perfect strategy for Sadie Hawkins Day.”

  “I know. Run fast.” They laughed.

  Allison measured Katie’s height and weight. “All good,” she pronounced. Katie sat on the examination table. Allison pulled a stool close.

  Allison understood the principal diagnostic tool for any primary care physician wasn’t a lab test or a machine but asking the right questions in such a way as to produce useful, honest answers. So as she examined Katie’s eyes, nose, ears and throat, Allison pumped the teenager for information.

  “How’d the soccer team do?”

  “Decent. Fourteen and four.”

  “School’s good?”

  “It’s nice being the highest grade in middle school. I can’t believe how young the fifth graders are.”

  “Already on the way to being old and gray,” Allison chuckled. “Like me.”

  “No way! You’re a cougar. Half the boys in my class have a crush on you.”

  “Cougar, huh?” Allison smiled.

  “Definitely.”

  “How are the grades?”

  “All A’s.”

  “How’s your dad?”

  “Okay, I guess. He misses Mom a lot.”

  “How about you?”

  “I miss her. Lots of times I wish I could talk to her. I talk to Dad but it’s not the same and it’s awkward with some stuff.”

  “Like boys?”

  “Yeah and other, you know, girl things. Sometimes boys can be so dorky.”

  Alison laughed. “You have a boyfriend?” It wasn’t a social question. Having a boyfriend meant a whole array of potential health issues a physician needed to watch out for, from pregnancy to abuse.

  Katie eyed her seriously. Allison saw in the girl a wariness—and weariness—beyond her years, a wisdom born of sorrow. Losing a parent at such a formative age, she knew, did things to a kid. Death was the great betrayer. Childhood’s end. Trust always became an issue.

  Allison wanted to enfold this girl, this lovely daughter of her deceased friend, in her arms and shield her from life’s many hurts and assure her that everything would be okay. But that in itself would be a betrayal of sorts and a lie. No one could protect anyone else from anything. Allison was positive of that. In the end, she knew, each of us runs life’s gauntlet alone.

  “This is just between us girls,” Allison added quickly.

  “I have friends that are boys.”

  Allison smiled. Despite the coy answer, she was getting more from Katie than she did from most teens, especially boys who generally responded to her inquiries with grunts. She plunged ahead.

  “Has your father had the ‘birds and bees’ talk with you yet?”

  “No. He tried but . . .” She crossed her arms over her chest and said, “Anyway, we learned that in school.” Allison knew she had pushed things about as far as she could. But there was one more question she needed to ask.

  “What about sex . . . ?”

  Katie flushed tomato red. “What? Me? Of course not!”

  “I’m glad to hear that. That’s a good decision for your health and for many other reasons. But if you are ever considering it, you should talk to me. Will you do that?”

  Again, the wary eyes. “Okay. But why?”

  “So I can try to talk you out of it, of course.” Allison gave her a crooked grin. “And, if I can’t, to make sure you’re p
repared.” She steered the conversation back to simpler topics. “Any asthma or breathing problems?”

  Kate shook her head.

  “Fevers? Night sweats? Trouble going to the bathroom?” Another head shake. “Aches, pains?”

  “My leg.”

  “Tell me about it.”

  Katie pointed to her left leg directly below her knee. “It started about a month ago. It hurts if I press it.”

  “Does it ever hurt on its own?”

  “Sometimes.”

  “Has it gotten worse?”

  “I’m not sure. But Dad said we should see you because it hasn’t gotten better.”

  Allison applied moderate pressure with her thumb. Katie winced. “Tender.” Allison observed.

  “It’s not bad. I’ve been able to play through it.”

  Allison massaged the joint. She felt nothing amiss structurally. She noticed a bruise. “Did you get kicked here?”

  “Of course,” Katie laughed. “And everywhere else.”

  Allison had Katie dangle her legs over the edge of the table and thwacked her left knee with a rubber-headed hammer. Katie’s leg shot forward. She repeated the test on the right leg with the same result. “Reflexes normal,” Allison said. “Could you have injured it any other way?”

  “Maybe. It started hurting a few days after I jumped out of a tree.”

  Allison compared Katie’s right leg to her left. She found no apparent differences. “What were you doing in a tree?”

  “Getting a soccer ball that got stuck up there.”

  “How high did you jump from?”

  “Not very high.”

  “Higher than you are tall?”

  “Yeah.”

  “But you don’t remember your leg hurting when you landed.”

  “No.”

  Allison considered the possibilities. Katie’s mobility wasn’t compromised, so she felt she could rule out a tear of the meniscus as well as damage to either of the collateral ligaments—good news since both injuries often required surgery and could be career-ending. A torn or strained muscle was similarly unlikely. That left two obvious culprits: bleeding between the leg bone and the periosteum—a deep bone bruise in layman’s terms, likely the result of being kicked above the shin guard—or a stress fracture, perhaps from so much soccer, perhaps from jumping from the tree. Unlike a regular fracture, the precipitating event for a particular stress fracture could rarely be determined.

  Bone bruises were painful but generally required no treatment. Stress fractures were another matter, usually requiring at least a month of limited activity. A stress fracture would mean no soccer.

  Allison leaned toward the bone bruise diagnosis. The pain from a stress fracture was likely to be more constant than the occasional symptoms Katie had reported. That she had noticed the pain after jumping from the tree was likely coincidental, although the jolt could have aggravated the bruise. But she couldn’t be sure.

  “Probably a bone bruise,” she told Katie. “Once you stop getting kicked in the shins every day, I suspect this will take care of itself. But I’m going to take an x-ray, just as a precaution.”

  “I can still go to camp though, right?”

  “I’ll clear you for camp, pending the x-ray. You’re not going to damage it if it’s a bone bruise. If it starts to hurt more, just stay off it for a while. Ice every day. And don’t jump out of trees.”

  “But I like to climb trees.”

  “Then try climbing down the tree after you’ve climbed up it.”

  Katie gave her a grin and slid off the table.

  “Not so fast,” Allison consulted Katie’s file. “You’re due for a tetanus shot.” Katie made a face. “I can’t sign the camp form without it.” Katie sighed. Allison administered the booster and took the leg x-ray. When they were done, she escorted Katie to the waiting room where Josh stood reading the bulletin board.

  Allison had hardly seen him since Sharon’s death. Sharon had been their link and the link had been broken. The limited contact was probably merciful, she decided. Sharon would have been the topic of conversation. The wound was still too raw for both of them. The loss of a young woman, a dear friend, of her own age was real enough for her. She couldn’t imagine what it was like for Josh. Still, she found herself happy to see him. He looked stronger than the grief-ravaged husband he had been at the end and he positively lit up at the sight of his daughter.

  “Katie looks fine,” she reassured Josh. “I gave her a tetanus booster and took a precautionary x-ray of her leg but I don’t expect to find a problem.” Allison made a point of looking directly at Josh and at his daughter, acknowledging the girl’s status as a full participant in the conversation about her own well-being.

  “That’s good news,” Josh said. “How about the permission slip?”

  Allison knew her own father—an unwavering stickler for doing things by the book—would never have signed the camp form without the results of Katie’s x-ray. But she had adopted a more flexible approach that started with: Do what’s best for the patient. “Sure,” she said. “It’ll save you a trip.” She signed the form and handed it to Katie. “If I see anything on the x-ray, I’ll let you know.”

  When they were gone Allison removed her lab coat, collapsed into the black high-backed leather chair behind her desk, and slipped off her shoes. She was starting to unwind when Coretha Hall, her nurse assistant, entered and plopped an armload of files on her desk. Allison stared at them. “Tell me again why I wanted to be a doctor?” she sighed.

  Coretha laughed. “Your father used to sit right there and say the same thing. He just hated the paperwork.”

  Allison flipped her hair over the back of the desk chair. “What did you tell the old man?”

  “I’d say, ‘Dr. Wright, you were young and naïve. You must not have known what you were getting into.’”

  “I suppose I can’t use that excuse.”

  “No,” Coretha agreed. “For as long as you dilly-dallied around, I’d say you can’t.”

  Coretha was, Allison decided, equal parts compassion, humor and no-nonsense. Perfect for a nurse. In that way, she reminded Allison of her mother. It made sense since both women had served the same demanding man—her father—for much of their lives.

  Coretha’s dark skin contrasted with her white cotton nurse’s uniform. Oversized bright red glasses hung from a cord around her neck. She lifted them to the end of her nose and looked at her watch. “Quitting time,” she announced.

  “You go ahead.” Allison waved at the files on her desk representing the day’s cases. “I’ve got paperwork.” She grabbed the file of Ricky Scruggs. “People don’t understand piercing is surgery,” she said. “You can’t use equipment that hasn’t been sterilized.”

  “That what caused his problem?”

  “Odds are. He did it himself.”

  Coretha shuddered. “You wouldn’t catch me doing that. Is that what happened to the woman with the earlobes?”

  Allison replayed her mental tape until it got to the prior week and the small, mousy woman with scraggly hair, her earlobes hot with infection that spread in flaming spikes across her jaw and down her neck. She hadn’t thought of her when Scruggs showed up and she decided there was no reason she should have.

  “The woman had her ears pierced years ago, not recently. Interesting coincidence but unrelated.” Allison opened Scruggs’s folder.

  “C’mon,” Coretha implored. “Let’s lock up and get out of here. At least one night, you need to go home. If I’d known it was going to keep you here tonight, I’d have kept the paperwork on my desk. Anyway, it will still be there tomorrow.”

  “Exactly.”

  Coretha put down her purse. “You need a life, honey. Family. A husband. You can’t hit the snooze button on your biological clock forever.”

  Allison made a face. A
t age thirty-seven, the issue was a sore spot. If anyone other than Coretha had brought it up . . .

  “Just because you couldn’t make it work the first time . . .”

  Allison returned to the file and focused on the first page. “See you tomorrow.”

  Coretha stared at her a moment then gathered her purse and left.

  A few minutes later, unable to concentrate, Allison picked up her keys, passed through the reception area with its tired collection of faded vinyl chairs, Formica coffee tables and tattered copies of Ladies’ Home Journal and Field & Stream, locked the beveled glass door with the sign that still read Winston Medical Clinic, Horace Wright, M.D. and headed for home. Hippocrates met her at the door, rubbing against her leg and purring. At least the cat was glad to see her.

  She popped a low-cal frozen casserole into the microwave, ate a quick dinner and crawled into bed. She started to reach for the stack of medical journals at her bedside but reconsidered and snapped off the light. She reviewed the events of the day. She decided she would recheck the file of the woman with the earlobe infections. Seconds later, she was asleep.

  Chapter Three

  Harry Dorn saluted, waved and strode off the ballroom stage of the Greenbrier Hotel with his audience in the middle of a standing ovation. Always leave them wanting more, he had learned early on.

  As often as he had given the Liberty Agenda speech, it never failed to inspire almost everyone in the audience—including him. Tonight had been no exception. He’d been at the top of his game, and it couldn’t have come at a better time. He’d done a table count during the Pledge of Allegiance. There must have been six hundred people in the audience. And the introduction! “Ladies and Gentlemen, the next senator from West Virginia and the future president of the United States!” Way overdone, but still . . .

  The applause continued as he slipped out a side door. Before the speech, he’d been tired, dying to get out of his monkey suit and out to his weekend retreat on the river at Possum Island. But the speech had energized him. He was on a roll, eager for the next item on the agenda.