Richard Mabry: Diagnosis Death

"Dr. Gardner, are you ready to see patients?"

Elena turned. Mary, the pert, dark-haired clinic nurse, held out a chart.

"Thanks, Mary. Yes, I'll start."

For Elena, the patients in the family practice clinic presented the same challenge as a Sudoku puzzle-except the stakes were much higher. She opened the chart and scanned the notes Mary had made. "42 y/o WF. 3 mo. Hx vague aches, lack of energy. BP 110/60, P 68."

"History of vague aches and lack of energy." Could be something, could be nothing. Elena tapped on the door and entered. "Hi, I'm Dr. Gardner." She extended her hand.

"Emily Gunderson." The woman's handshake was lukewarm, matching her expression.

"How can I help you?"

The woman perched on the edge of the exam table appeared to be closer to 55 than 42. Her eyes were dull. Her voice was husky and soft. She picked at a broken nail as she spoke. "I'm tired all the time. I feel like I've got a lump in my throat. I ache all over. I.. . I feel terrible."

A century ago, doctors would have attributed these symptoms to emotional problems and called the condition "neurasthenia." Elena gave thanks for the strides medicine had made since then. "When did this start?"

"Maybe three or four months ago."

Elena moved behind the woman and placed her fingers lightly on her neck. "Swallow for me, would you?" She increased her pressure slightly. "Again."

Elena continued to ask questions as she examined the woman's chest, heart, abdomen. Finally, she took a rubber-headed reflex hammer from the table and tapped gently at the bend of the woman's elbows and below her kneecaps. Reflexes diminished, no doubt about it.

"Mrs.-" She checked the chart. "Mrs. Gunderson, I'm going to order a couple of blood tests. If they confirm what I'm thinking, we should be able to get you back to your old self pretty quickly."

For the first time since the exam began, there seemed to be a spark in the woman's eyes. She leaned forward, apparently eager to catch Elena's words. "Did you say what I think you did? You can do something about this?"

"I think you've had an episode of what we call thyroiditis-an inflammation of the thyroid gland. It left part of the gland unable to make thyroid hormone, which is why the rest of your thyroid enlarged to compensate." Elena ran her fingers over the area to demonstrate. "But it still isn't making enough thyroid hormone. That makes you tired. It causes you to ache all over. Does cold bother you? Do you have trouble in an air conditioned building?"

The woman looked at Elena like she'd pulled a rabbit out of a hat. "How did you know?"

"It's my job to know that, Mrs. Gunderson. No trick to it." Elena ticked a few boxes on the lab request sheet clipped to the front of the chart. "The nurse will draw some blood for tests. I want to see you back in a week. If I'm right, we'll start you on a medication called levothyroxine. It may take a bit of dosage adjustment, but I think you'll soon feel like your old self."

"No surgery?"

"No, did someone suggest that?"

Mrs. Gunderson ducked her head. "Well, I saw another doctor last month about this. He said I probably needed surgery. I guess now he meant surgery on my thyroid. But when he found out I didn't have insurance, he sent me here to the charity clinic."

Elena fought to keep her voice level. The surgeon might have made a diagnostic mistake. Then again, he could have decided that, in the absence of insurance, a referral would be a good idea. "If you'll tell me the name of that doctor, I'll call him. I'm sure he'll be pleased that no surgery is necessary." And if he punted this poor woman because there was no fee in sight for him, he's going to get an earful.

Elena struggled upward from sleep like a diver returning from the depths. She opened one eye and frowned at the strident tones that assaulted her eardrums. Phone? She lifted the receiver and was rewarded with a dial tone. Pager? Her frontal cortex slowly ground into gear and returned the message: nope, different sound, not the same cadence as her pager. She reached across her body, pushed down the pillow in which her head was nestled, and saw the flashing red numerals on the bedside clock: 6:01.

She slammed her palm down on the bar to silence the alarm and tried to recall why she had to get up. Did she have early morning rounds at the hospital? Was there a conference at the medical school? No and no. What is today? It had to be… Saturday. Then it all came tumbling back.

Today she was driving to Dainger to meet Cathy Sewell. Driving to Dainger? No, if anything, she hoped she was driving away from danger. Away from the midnight phone calls, leaving behind the notes with the threatening messages, trying to flee the guilt that enveloped her every time she came near the ICU at Zale Hospital. Surely no danger awaited her in Dainger-only the hope of a better tomorrow.

Elena rolled out of bed, scuffed her feet into slippers, and hurried to the kitchen. She needed coffee, lots of it. She flicked the switch to set the already-prepared pot brewing and padded off to the bathroom, thankful she'd stopped at the store and bought yet more coffee last night.

Back in her bedroom, she chose and rejected three outfits before settling on a blouse and slacks that seemed casual yet professional. Wasn't that coffee ready yet? Elena walked through the kitchen door in time to hear the coffeemaker give one last gurgle and fall silent. She poured a cup and burned her tongue with the first sip.

She stumbled to the bathroom and risked a glance at herself in the mirror. She recoiled when she saw her eyes-a network of red lines turned the whites into a roadmap. She recalled a movie based on the life of dancer Bob Fosse, a man who burned the candle at both ends on a regular basis. Scene after scene portrayed him gazing at his dissolute face in the morning mirror and murmuring, "It's showtime." Eye drops and a stimulant pill and he was off for another day.

Well, there'd be no Dexedrine, but some eyedrops and a bit of wizardry with makeup wouldn't hurt. It was indeed showtime.

"If you don't like that rug, tell me," Will said.

Cathy turned to where he sat in the living room, newspaper in hand, coffee at his elbow. "Excuse me?"

Will lowered the paper and gave her a smile. "If you don't like that rug, tell me. Don't keep pacing, trying to wear it out." He looked at his watch. "It's ten-twenty. Dr. Gardner said she'd be here about ten-thirty. She's not late. Does everybody have to be early, simply because you always are?"

Cathy shrugged. "I guess I'm nervous about this interview. I want it to work out-I mean, I need someone to cover my patients while I'm out with the baby-but I don't want to take her into the practice and then regret my decision." She resumed pacing, caught herself, and stopped to rearrange the magazines on the coffee table.

Will gestured toward the easy chair that sat at right angles to the one he currently occupied. "Get a cup of coffee. Sit down and relax."

"You know I can't have coffee," Cathy snapped.

"Sorry. I forgot. Maybe some herbal tea. But-"

The sound of the doorbell put an end to the conversation. Will's eyes followed his wife as she made her way to the door. Cathy stopped, took a deep breath, and admitted the visitor.

Will didn't listen to the conversation. He already knew what it would be like. "Dr. Sewell?" "Call me Cathy." "And I'm Elena." "Now I remember you." "You haven't changed a bit." Instead, he focused on Dr. Elena Perez Gardner.

Will was happily married, rarely looked at another woman, but Elena's appearance was more than enough to get his attention. Mid-length, black hair was pulled back into a ponytail to frame a beautiful oval face with high-set cheekbones and flawless skin the color of honey. Will decided her body would be the envy of most women and definitely merit a second and third look from almost any man.