Michael Palmer - Fatal

"So, Kyle, what's the deal?"

Skin pale, palm creases pale, nail beds pale. Jeannie might be right about his being spooky, he thought. Anemia of some sort was already at the head of the list of possibilities.

"Ah got up ta take me a piss an' got all dizzy, Doc. Lewis says Ah passed out, but he tends ta zaggeration."

"Any pains?"

Pulse thin, rapid.

"Jes the usual."

"You drinking much of that rotgut you guys make out there?"

Betty soft. Maybe a little protective muscle tightening over the stomach.

"A course Ah am. But so's the rest a the boys."

"Your stool any unusual color?"

"My what?"

"Your stool. Your bowel movements."

"My what?"

"Your shit, Kyle. Your shit."

"Oh, that. How should Ah know? Nobody in their right mind 'ud ever look down thet outhouse hole."

"Whazza story, Doc?" Lewis asked.

"I don't know, Lewis. Maybe low blood."

"You'll fix him up."

"I'll fix him up, Lewis."

Matt did an efficient but detailed physical exam that showed a significant drop in blood pressure when Kyle sat up. Low blood volume, low blood count. Anemia. Now it was time to look for a source of blood loss, starting with the most likely. Matt pulled on a rubber glove.

"Whazzat fer?" Kyle asked.

"I think you can guess, Kyle. Roll over, face the wall, and pull your knees up toward your chest. I need to see if you're bleeding inside."

Kyle did as he was asked, but the moment Matt's gloved finger touched his anus, he shrieked, stiffened his legs out, and began bellowing over and over again like a wounded beast. The staff — two nurses and the ER doc — came charging into the room.

"Ah din't think he 'uz gonna lak thet," Lewis drawled.

"Well, why in the hell didn't you say something?" Matt replied, much louder than he had intended.

Jeannie Putnam and the two others stood at the doorway, transfixed. Matt, his gloved finger pointing skyward like a fan at some bizarre sporting event proclaiming his team was number one, smiled at them sheepishly.

"I… don't think I waited long enough for Kyle to agree to this procedure. Apparently it's a touchy area for him."

"Apparently," Jeannie said. "Urn, Dr. Rutledge, can we be of any help?"

"Well, actually, you can be sure that blood you sent is cross-matched for six units, and you can tell the lab we really need his hematocrit."

"Is he bleeding internally?"

"That's my guess."

"Guess?"

"I'd be a bit more certain if I could get some stool to test for blood. Kyle, how about if I go up there with a little Q-tip?"

"Nope."

"Look, Kyle. It's three-thirty in the morning and you're sick and I have to know why. Now, either you let me do the procedure I want to do, or I promise you I'm going home and back to bed."

"What?" Kyle and Jeannie exclaimed in unison.

"Ya wouldn't leave me, Doc," Kyle said.

"Oh, but I would. Believe me, I would. Dr. Ellis here can take care of you for now, and in the morning they'll find you another doctor. That is, provided you're still alive in the morning. Now, what's it going to be?"

For half a minute, there was only silence. Then slowly, Kyle rolled back to face the wall and drew his knees up.

"Darn but yer an ornery summabitch doctor," he said. "Y'uz ornery as a kid an' ya jes got worse since then."

"I'll be gentle, Kyle," Matt replied.

By six-thirty, the impending crisis surrounding Kyle Slocumb was over. The hard-won rectal exam disclosed black stool that tested positive for blood. Perhaps cowed by the procedure, Kyle put up little resistance to swallowing a thin plastic tube, which Matt slid up one nostril and down the back of his throat into his stomach. Years of smoking potent homegrown cigarettes had done in his gag reflex, making the often difficult insertion a snap. The stomach contents aspirated through the tube were old blood (coffee grounds in appearance) and some streaks of fresh, bright red blood as well. Transfusions had quickly replaced the lost blood and circulating volume, so that by the time Kyle was wheeled into the GI Suite for an examination through gastroenterologist Ed Tanguay's scope, he had recovered his color and stabilized his blood pressure.

"So thet's it," Lewis Slocumb said as he and Matt walked together out of the ER. The dewy morning air was fragrant.

"Just about," Matt replied. "We'll keep our fingers crossed that all Dr. Tanguay finds is some gastritis. That's like inflammation of the stomach lining. If it's a little ulcer, that'll probably be okay, too."

"But if'n he got cancer he's finished."

"Not necessarily. We can cure stomach cancer with surgery. But let's not go there until we hear what Dr. Tanguay finds. We're lucky he could do Kyle so quickly."

"If'n thet doctor sez ol' Kyle has to stay overnight, Ah think he'd jes leave."

"I was thinking he ought to stay anyway, just to get some medicine for his stomach and maybe another transfusion."

"Ah tell ya, if'n he kin walk, they's no way he'll stay."

"I got him to let me do that exam, Lewis. I can talk him into staying."

Lewis Slocumb turned and looked up at Matt. The sharpness in his blue-green eyes was belied by the rest of his weathered, scruffy face.

"Wer different, Matthew," he said. "It's a way we done chose fer ourselves an' it don' mean nothin' ta us thet mos' folks think wer crazy or sick or evil. Thet is, 'til we cross the line inta their world. It ain't nothin' we enjoy doin', b'lieve me it ain't. Kyle an' me crossed thet line this mornin'. Now we want ta cross back as quick as possible. So yew make thet happen, Doc, an' we'll take our chances. Our kind, the mountain folk, unnerstand thet so long's ya don' hurt no one, ya kin be whoever ya want. Mos' people down here in town ain't none too pleasant ta us, an' thet goes fer yer hospital, too."

Matt was so astonished, he could barely reply. Lewis Slocumb hadn't called him anything other than Doc since his return with his M.D. He had also just spoken more words than Matt could ever remember.

"Okay," he managed. "I'll do what I can to get Kyle out of here. But if I think he's in danger, you're going to have to sign him out against my advice."

"We'll do thet. An' donchew worry none. We ain't gonna sue ya, no matter what."

He guffawed, coughed, and spat.

Matt gazed east at the flush of morning sunlight brightening the sky from behind the hills. As he did so, he slipped his hands in his pockets and connected with the envelope.

"Hey, Lewis, tell me what you make of this," he said, handing it over.

He felt pretty certain that all of the Slocumbs could read to some degree or another.

"Don' make nothin' of it," Lewis said.

"You mean you don't know what the guy who wrote this note is talking about? You don't know where the cleft is?"

Lewis scuffed at the ground with the toe of his worn high-cuts.

"Ah mot know, then agin Ah mot not."

"Lewis, I just saved your brother's life, and I've been coming out to the farm to check on you guys for years. This note is very important to me. It has to do with the mine."

"Ah know what it has ta do with. Ya really got a burr up yer butt fer thet ol' mine."

"I have good reasons," Matt said, suddenly exasperated. "My father and my wife, for two. A couple of dead miners, for two more… Lewis?"

"Ah 'preciate what ya done fer Kyle in there, Ah surely do."

"So?"

"It's really thet important ta ya?"

"It is. I put out notices offering a reward for information about illegal chemical waste dumping by the mine, and this note was slid under my door."

Lewis scuffed thoughtfully, covering up the gouges he had made in the sand.

"So, whar's the big news?" he asked finally.

"What do you mean?"

"Ah mean, they's lotsa folks livin' in the woods what knows 'bout the cleft an' the tunnel and even 'bout the crap the mine people keep inside."