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DEADLY REMEDY
A Rhea Lynch, M.D. Novel (Book 3)
Author: Gwen Hunter
2013 Reissue Edition
5.5"x 8.5" Trade Paperback
Retail $15.95; 288pp
ISBN 978-1-62268-024-5 print
ISBN 978-1-62268-025-2 ebook
LCCN 2013953708

Also available as Unabridged Audible Audio Edition

Prologue

I never put much stock in omens and portents, but that strange August Wednesday had been rife with them, according to Miss Essie, who knew more about such things than I ever would. Temps went from typically hot and muggy to oddly cool and wet as a Canadian front blew through. And the appearance of sun-dogs and a double rainbow on the heels of a nasty summer lightning storm, together with the screaming crows perched high in the trees, were portents enough to have the older woman muttering to herself and banging pans in her kitchen.
    When I stopped by on the way in to work, I tried reminding her that the rain was a welcome relief, drenching the overheated earth and straw-dry crops still in the fields, making a dent in the awful drought we had been suffering, and bringing cooler weather. Miss Essie was having nothing of it. When I left her, she was casting dark glances at the sky and talking to God as if He had made a mistake somewhere and needed her advice to fix things.
    I, on the other hand, reveled in the sudden return to fresh air and temperatures in the eighties. Delighted in the vision of brilliant rainbows on one horizon, framed against furious purpled clouds. Loved the sun-dogs—weird refracted spots of light to the left and right of the sun on the other horizon. It had been breathtaking for all of fifteen minutes just after the storm passed. Now, as I left Miss Essie's and drove in to the small rural ER of Dawkins County, South Carolina, they had all faded. The sun-dogs had vanished. The rainbows were little more than broken curves low in the sky. And the black crows that alighted in the topmost branches of the white oaks in the woods between Miss Essie's home and mine were not a harbinger of death and change. No matter what Miss Essie said.
    Omens. Portents. Hogwash.
    Simply a prism of sunlight refracted through rain-mist on one side, and sun-dog-forming mile-high ice crystals on the other. Science. Meteorology. Just big black birds celebrating having lived through the wind and lightning, flapping their wings and calling out to other birds. Nothing more. Though ice crystals in August were rare. After all, this was the South. And crows usually didn't make that much noise.
    Still, I had experienced enough of the religiously weird recently and I wasn't buying into any more. I had helped put the Reverend Lamb of God behind bars and seen his TV station shut down. And lived to tell about it. I wasn't going to listen to spiritual nonsense, no matter what happened in the heavens.
    At 6:00 p.m., I pulled into the doctors' parking lot of Dawkins County Hospital, where I worked under contract as an ER physician, and knew instantly that it would be a busy night. The surrounding parking area was filled with cars and trucks, many with yellow emergency lights affixed to the roofs. Three county ambulances, two rescue squad vehicles loaded with equipment, a fire truck, and a crowd of milling people met me. Hot time in the old town tonight. Busy? Yes. Kaleidoscopes and rainbows? Definitely.
    Omens? Portents? No way.

Chapter 1
Storms and Misery

The storm started three brush fires and kept the rescue squad on its toes, though the rain put the flames out before extensive damage was done. Fire wasn't the reason why my ER looked like a major disaster area. The bus accident on I-77, about nine miles from the hospital, had a far greater impact. And lightning had hit the hospital, resulting in minor damage to the surgical department and bringing out the rest of the county crews and volunteers.
    I spent half an hour treating minor burns, cuts, and scrapes so my boss could head home. We usually switched shifts at 7:00 p.m., but I owed the hospital some time. Together, Dr. Wallace Chadwick and I moved patients in and out and cleared the backlog of victims before he left for the night. It was good to get the place emptied out and start with a clean slate.
    While the nurses changed shifts and the security guard made rounds, I settled in. Ignoring the weakness in my healing back muscles, I picked up my bag, abandoned under a desk chair in the nurses' station, and headed up the hall. On the way I took in a brisk earful from Trisha Singletary, the nursing supervisor called in to help deal with the mess. She was shorter than I, cute and buxom, and had a way with men that bordered on the mystical.
    "It's mostly over now, but Dr. Rhea, you shoulda seen the smoke. I was clocking in when it hit—the lightning, I mean. It shook the whole building, made the lights go out. Knocked a hole in the last surgical suite, up high near the ceiling, and let in rain and leaves. Ruined any pretense at sterility. There's smoke damage in two rooms. Thank God they weren't doing the procedure in either one."
    "Someone was cutting at the time?" I asked, as I led the way to my call room. It was calmer in ER but I didn't know how long that might last, and I wanted to drop off my overnight bag, make sure the call room had clean sheets and towels.
    "Dr. Haynes was assisting Statler with an appendix on a seven-year-old with muscular dystrophy. Statler was closing and the lightning hit. Lorella Shirley—you know her?"
    I shook my head no, tossed my bag to the bed, checked the room for cleanliness and decided it was fine. Locking the door behind me, we started back to the ER.
    "Well, she's an OR tech, and she said she jumped outta her skin when it hit and landed on a tray of sterile instruments. Statler started cussing and Haynes slipped and fell on the anesthetist's equipment. Lights were out about twenty seconds before they came back on. And to make it worse, Lorella said she saw a bat fly through."
    "A bat." I would be careful not to mention that part to Miss Essie. It would surely feed her omen talk.
    "It musta found its way into the eaves from outside and been sleeping there till dark, then got knocked out of its place by the lightning. Now it's inside. The kid's okay, and the maintenance crew has a tarp over the hole. The fire started by the lightning was put out by the rain, but fire crews are here to make sure nothing is still hot in the walls."
    As she spoke, a fireman in full protective gear, heavy coat, boots, gloves, helmet tucked under his arm, approached. Trisha slowed, preened and stuck out her chest a bit, though her impressive bustline didn't require any effort to draw the man's attention. He slowed, too, and smiled, and after a moment, met her eyes.
    "Miss Trish. You gonna be at McDowries Bar and Billards Friday? They got a deejay with shagging." The fireman's dark eyes held hungrily to Trisha as he mentioned the state dance of South Carolina.
    "That divorce finalized yet?" she asked archly. Trisha was perpetually looking for a man, but her standards were well known in the area. Married men were not a part of her social calendar.
    "Last Monday. I'm a free man." They both kept moving as the flirtation continued, turning and walking backward in the halls.
    "I may be there." She flipped back an imaginary strand of hair, touching her neck in the process, the motion unconsciously sexual. "You can buy me a drink to celebrate."
    A wide grin split his face. "It's a date."
    "Well, I wouldn't go that far. But you catch that bat, I might consider dancing with you."
    "Not my job, gorgeous. But speaking of bats . . ." The fireman pointed past us at a dark corner just ahead.
    Trisha jumped and stared, then shivered. A dark form moved in the corner, turning its head as we neared.
    "Lordy, I hate bats. I'll get the cops after it now. When's this backwater county gonna get an animal control officer?" she demanded of the fireman. But he was gone.
    "Close the fire doors to the other wings," I recommended, "and trap him here. And be careful. A small percentage of bats carry rabies."
    "Well ain't that just fine and dandy," Trish muttered. "A big strong man all dressed out to save me and he can't kill a single little old flying rabies factory."
    I grinned. The recently divorced fireman had passed up an opportunity to play knight in shining armor to the damsel in distress. If he had visions of dancing Friday night with his Miss Trish, I figured he was in for a disappointment.
    My beeper went off, the code in the little LED window displaying the ER extension followed by the numerals 911. "Got an emergency, Trish." I half-jogged away from her. "If it stays quiet, I'll spring for pizza for the ER crew around nine. Join us if you like."
    "Beep me if you need help," she said. "Oh, and we got a whole bunch of new agency nurses starting tonight, so things may be a little chaotic."
    "Little chaotic?" I said to myself as I rounded the corner to the ER. The emergency scanner crackled with coded general information, and the ambulance scanner with more specific info, reporting on a patient being brought to the ER, code three. I had a sixteen-year-old female quadriplegic with a severe headache, shortness of breath, and blood pressure that was sky high. My best guess from hearing the paramedic's report was autonomic dysreflexia, or toxic hypertension. That was a dangerous condition in a quadriplegic, sometimes resulting hemorrhagic stroke, respiratory shutdown, and death.
    "From the address, I can tell it's Venetia Gordon," Anne, one of the ER nurses, commented.
    The ability of a nurse to tell a patient's name just by the address was not particularly unusual in Dawkins. The rural county had around fifty thousand residents, and just like any business, we had our regulars. "Do we have an old chart on her?" I asked. I wanted to see the original report on the cause of the girl's paralysis, and a breakdown of everything that had happened to her since.
    "She was in the ER last week," Anne said. "UTI from a permanent catheter. But the original accident happened six months ago down in Lancaster County. Two car MVA on a back road," she said, referring to a moving vehicular accident—medspeak for a car wreck. "They flew her out from the scene to CMC in Charlotte. Except for a minor infection, you'll be flying blind."
    "Lovely. Ask the crew where the spinal break occurred."
    When the scratchy words came back at C4, I sighed. Vertebrae were named and numbered from the base of the scull to the tailbone, with cervical vertebrae at the top. The lower the number, the greater the amount of paralytic damage. Damage at C7 would have left Venetia's upper body under her own control. At C4, things could get dicey.
    I told Anne what I would likely need in terms of meds and equipment, and asked her to get respiratory therapy down here stat. If this girl crashed, I wanted help getting her intubated and on the ventilator. There was an old saying, "C3, 4, 5, keep you alive." My patient was barely in the safety zone. Anything could happen with spinal damage at that location.
    Anne nodded, writing nothing, remembering everything. She was a medium woman in every way except her memory. Medium-length medium-brown hair, medium height, medium weight, medium disposition. But her memory was phenomenal, as I was learning. Tell her something once and she'd remember it forever. And she was really great in an emergency, which was a good thing, as the other RN on duty tonight was a newbie, fresh out of nursing school and likely useless. She'd get good eventually, but for now she needed to be watched so she didn't kill somebody. Coreen was her name. Dark-skinned and brown-eyed, petite as a model, and twenty years old. So fresh-faced and innocent she made me feel ancient at twenty-nine.
    Venetia Gordon, still with the healthy-looking limbs of her pre-accident life, was wheeled in, strapped to an ambulance gurney. She was breathing fast and shallowly. Not much air was being exchanged.
    The girl was on 100 percent oxygen but her color was poor, an ashen blue shade that told me her lungs were shutting down. I looked at the monitor sitting atop the stretcher as the EMS guys moved with her: blood pressure 230 over 145. Pulse 72. I bent over her head, moving with her as she was swept into the cardiac room, and checked for papilledema of her optic nerves. They looked fine, no swelling that might lead to blindness if not corrected. "What is her O2 sat?" I asked, referring to the oxygen saturation level.
    "Eighty-four percent last time we checked the pulse-ox," a voice answered, referring to a device that clipped to a patient's finger and measured both pulse and oxygen levels.
    "I want ABGs, repeat O2 sat, and Catapress PO," I said, ordering the same tests and drugs I had mentioned to Anne only moments before. I told them the dosage and stood back as the EMTs lifted the patient and moved her to the ER stretcher. "How long on the ABGs?" I asked no one in particular. My attention was on the patient's ragged, shallow breathing. There was a look of panic in her eyes, a mottled appearance to her skin.
    "Beth?" Anne asked the lab tech.
    "Fast. Maybe three minutes."
    ABGs referred to arterial blood gases, which would tell me how well or poorly Venetia's lungs were working. I positioned my stethoscope on her chest. While not much air was moving, there didn't appear to be any fluid buildup. Her skin was damp and cold, not feverish. Not pneumonia, then. Symptoms matched classic toxic hypertension. At least, so far.
    "Get me an EKG after you get the ABGs back. Family here with her?"
    "I'm her mama. Almera Gordon."
    I turned away from the sight of the lab tech drawing blood gasses to the soft voice, and found a timid-looking woman, mousy brown all over, wearing sturdy matronly shoes and a sturdy matronly skirt, her hair pulled back in a tight bun. But her eyes were amazing. Wide and a vivid deep blue, almost lavender, fringed around with odd double lashes, thick and lustrous. Her entire demeanor may have been subdued, but her eyes claimed something else about her, a hidden strength, some powerful determination. I nodded at her. "Tell me what was happening when this started."
    Mrs. Gordon checked her watch. "At six p.m. I got her outta the bath. The water temp was jist warmer than tepid, and she wasn't in for very long," she said, anticipating my next question. Quadriplegics were not supposed to spend much time in heat, which could cause all sorts of weird things to happen to them. "I dried her off, got her half-way dressed in PJs and swung her to the bed."
    "Swung? You have a transport sling?"
    "On moveable tracks, but we usually keep the system set up between the bathroom and bed. It makes bathing her jist so much easier," she said in her drawn-out mill-hill accent.
    I nodded my understanding.
    "O2 sat on the pulse-ox is 82 percent, Doc. BP 242 over 147," Anne said.
    I checked my watch. "Blood Gases?"
    Beth put the result strip in my hand. Venetia's pH was 7.053, her CO2 at 74, and her O2 at 52. Not good. Her oxygen saturation levels matched the results for the pulse-ox. Bad all around. "Go on," I said, addressing Mrs. Gordon.
    "She seemed to be having trouble breathing. And she said her head was hurtin'. I checked her blood pressure and it was 190 over 120. Her eyes looked kinda funny, like she wasn't seeing so good. So I called the EMS."
    "When did you check her blood pressure?"
    "About 6:20."
    "The call came in at 6:24, Doc," an EMT said.
    "Blood pressure is still rising," Anne said.
    Panic bloomed in the dark-brown depths of Venetia's eyes. She was using accessory muscles to breathe, her shoulders lifted and the sternocleidomastoid muscles of the neck and the very upper chest stretched with effort, all the movement the girl could make to force in air. With her breathing so difficult, she didn't speak, but I understood her fear. "Venetia," I said, leaning over her chest, "Is your head hurting?" She nodded once. "Is your vision blurred?" She nodded again, the movement spastic and jerky. "Do you have a throbbing in your neck, right here?" I asked, brushing the skin over the carotid where the baroreceptors measured pressure in the carotid artery. Venetia nodded shakily.
    "I'm going to get your blood pressure down so your headache will go away, okay? And your breathing should ease at the same time." She managed a nod, lifting her shoulders slightly. Besides the desperate breathing, it was the only motion I had seen her make. "Bag her. Give another Catapress. Get me a Nipride drip ready."
    "Nipride is ready, Doc," Coreen said, her voice steady and composed.
    I raised my eyebrows. "Thanks."
    "And I got another line going," she added, indicating the IV line in the patient's right hand.
    The respiratory therapist moved into place beside Venetia's head and put a tight-fitting, blue plastic mask over her face. She attached an ambu bag and pumped the large balloon; 100 percent oxygen began to fill the girl's lungs.
    "Do you understand what's happening here?" I asked Mrs. Gordon, not taking my eyes from the girl.
    "Not to say," she said softly, which meant "not really" in the local lingo.
    "Injuries to spinal cords can be tricky things. Venetia's was six months ago?"
    The woman nodded, her eyes on her daughter with a single-minded intensity. "Six months ago next Monday.
    "Do you know if she had any sacral sparing?" I asked. When the woman looked blank, I added, "Does she feel anything anywhere on her body? Heat or cold? Pain? Pressure sensations?"
    "No. Nothing. My baby don't feel nothing," she whispered. "Dr. Danthari, her neurosurgeon, said she won't never feel no more than she does now. It's at C4. She had a lot of swelling there and it caused more damage than he expected."
    Spinal cord injuries often resulted in strange reactions, depending on the location of the injury. Even though there are only seven cervical vertebra, there are eight pairs of cervical nerves. Injuries on the dorsal spine will cause one type of sensory loss, injury to the lateral spine will cause other types, depending on which pair of nerves are affected. I had once seen a patient with a spinal fracture at C7 who had lost his intrinsics, responsible for abduction and adduction of the fingers and his ability to key-pinch—meaning that he was able to flex and extend all of his fingers and make a fist, but not able to pinch his car key or move his fingers side to side.
    I really needed to know what kind of injury Venetia had received, but there likely wasn't time to get a call through to her neurosurgeon. I told Anne to try to call Dr. Danthari, just in case, to cover my backside. She ran to the phone at the nurses' desk.
    "Her blood pressure is very high, and swelling may be what we're seeing here. The original injury could be causing pressure on the part of the lower brain that controls blood pressure, much higher than C4. The high blood pressure could then slow down her ability to breathe."
    Mrs. Gordon bit her lip, her almost-lavender eyes filling with tears. "I don't want her on no ventilator. She don't want to be on no vent."
    I checked the BP on the monitor. It was down a bit. I smiled at the woman.     "We'll avoid that if at all possible." I wasn't closing any doors, not on a patient who seemed fully aware of what was going on in the room. This was no brain-damaged person without the ability to interact with life. This was a vibrant young woman with a future ahead of her, especially if modern medicine made some small leaps in the next few years.
    "We got a living will. It's in the van," the timid voice sounded suddenly firmer.
The room seemed to go still. If her breathing deteriorated further and she was not put on a ventilator, Venetia Gordon could die. I crossed my arms over my chest and glanced quickly at Anne.
    "Would you get it so we can make a copy?" Anne said, reading my look.
    "Yes. Of course." The timid woman reached out and lovingly touched the unfeeling toes of her daughter before she turned and moved away on her sturdy shoes. Almera. Gordon was a sudden inconsistency—loving her daughter, yet willing to let her die.
    Checking my watch, I said, "Get the Nipride going. I want that pressure down." I bent over Venetia's chest again and listened. If I couldn't get her stabilized, I might have to initiate a legal battle to keep a sixteen-year-old-girl from dying. Slipping the stethoscope around my neck, I left the room and checked the administrative call sheet for the night. I wasn't letting this girl die without a fight.
    "Nipride's going," Coreen said through the open door.
    Rolanda Higgenbotham was on call for the night. Good. Rolanda was a take-charge, no-nonsense woman. I motioned Anne to the side. "When you get that living will, fax a copy to Ms. Higgenbotham and call her with the problem. I may need to intubate. And this is a minor. We may need DSS or a judge." Department of Social Services would remove the girl from her mother's custody and have her given lifesaving medical treatment. There wasn't any doubt about it.
    Anne nodded, her eyes troubled. Whatever we did with Venetia, it was legal trouble. To allow a mentally healthy minor to die was impossible. To ignore a legally correct living will was a nightmare. It would be a mess both legally and emotionally, no matter what I chose to do. But I had made my decision already and everyone around me knew it, except Mrs. Gordon and her daughter.
    "Pressure is dropping," Coreen said from the room where Venetia Gordon struggled, and fought the headache pain caused by high blood pressure. "It's 204 over 136. O2 sat is up to 90."
    "She's breathing easier," the respiratory tech said. "Bagging isn't as stiff."
    It was too soon to feel relief, but I felt a surge of comfort anyway. Leaving the room, I called Dr. Haynes, Venetia's medical doctor, and filled him in. The man sounded sleepy, as though I had interrupted a post-fire, post-surgery, post-embarrassing-spill-in-the-OR nap, but he instantly knew which patient I was dealing with, listened to the litany of symptoms, and then recommended admission. "Mrs. Gordon will say no. She always does. But offer it anyway. And call me back if you can't get the pressure down. She and Venetia saw a lawyer about a living will. It's pretty airtight." He yawned hugely, the sound making me sleepy. "We'll have to get DSS involved to get the girl on a vent. I'll come in and help you with the mother. She's a handful."
    "Thanks. If you don't hear from me, you'll either find her admitted, or sent home."
    I was holding a pair of latex gloves, and absently folded them and stuffed them into the pocket that held my reflex hammer, a small Maglite flashlight, and a collection of other medical junk I usually found myself carrying when at work.
    "Pressure is 198 over 130, pulse 81, O2 sat at 92." Coreen looked up at me through the door, her eyes bright with excitement. For a newbie, she was doing great. And she was young enough and inexperienced enough to still find the medical successes exhilarating. There were compensations for the lack of experience.
    Venetia's mom stood by the copier while Anne made copies, then folded the original papers that could end her daughter's life and slipped them in her purse. Returning to the cardiac room where Venetia lay, I stood to the side where I could view both mother and daughter without moving my head. Drinking a cup of coffee I scarcely tasted, I watched Venetia's color return to pink, her BP continuing to drop, her O2 sat rising.
    When Venetia could draw enough air to speak, she said, "My head feels a little better." I nodded at her, pleased.
    Mrs. Gordon sat through the procedures with tightly clasped hands and a strained face, body rocking slightly, silent, staying out of the way, but with her lips moving, her eyes tight on her child. I figured she was praying. There was no doubt she loved the girl. The living will was a mystery.
    Forty-seven minutes from the time Venetia was wheeled into the ER, I asked for a repeat ABG. The results were good enough for me to turn down the O2 and tell the respiratory tech to stop bagging her. At an hour and fifteen minutes, Venetia was sitting up, strapped in the bed to keep her from slipping down again, laughing and telling knock-knock jokes to the respiratory therapist. Her pressure was stabilized. Her breathing was near normal. The respiratory therapist was satisfied with her blood gasses, her O2 sat, everything. The threat of fighting a legal battle while trying to save a life had been neutralized, just that fast.
    I poured a couple cups of coffee and motioned Mrs. Gordon into the office the contract doctors used when working ER duty. It was little more than a closet, but it did have chairs and a desk and a new print hanging on one wall, depicting the Charleston Battery under attack by hurricane winds.
    "Venetia is going to be fine," I started. And then wished I could take back the words as Mrs. Gordon's face twisted in grief. Venetia was paralyzed. Fine was relative. I took a breath and started over. "You called 911 quickly enough for us to catch and treat Venetia's condition before it went too far. You did well, Mrs. Gordon."
    The woman nodded her head, still biting her lips. Her vivid lavender eyes were tear-filled but steady.
    "She developed a disorder called Autonomic Dysreflexia, or toxic hypertension. It's a condition, not uncommon in quadriplegics, caused by stimulation of the autonomic nervous system by something as simple as a urinary tract infection. It could have happened just by moving her from the tub, if her catheter got a slight yank. You understand what I mean by autonomic nervous system?"
    When Almera shook her head no, I said, "That's the part of the nervous system that controls automatic things like breathing and heart rate and blood pressure. In quadriplegics, it can be affected by many things. The blood pressure goes up fast and to frightening levels, and if not treated, can result in stroke and death. We have her stabilized at the moment, but I called Dr. Haynes and he recommended that she be admitted overnight, to monitor her better."
    The woman's face grew hard. Her hands, which had gripped one another repeatedly during treatment, began to work on each other again. The skin was rough and reddened from what appeared to be constant abrasion. "No insult to Dr. Haynes," she said steadily. "He's a good man. But my girl's seen enough doctors. Can't none of them fix her. A few say she could maybe get some feeling back. Maybe get some use of her arms. Maybe. But can't not a one of 'em fix her. And I'm not making her stay in a hospital any more than I have to. Not unless you say she'll die tonight without it."
    I shrugged, uncomfortable with the statement. Venetia could die at any time. Sometimes toxic hypertension could hit so fast, a five-minute wait for an ambulance might be the difference between life and death. It wasn't likely. But I had to consider the possibility.
    When I said this to Mrs. Gordon, her face hardened again, a mask of frustration that I understood. "You're jist riding a fence like all the others. Make sure you cover your backside so I can't sue. Well, you ain't got to live with a sixteen-year-old who can't move to even scratch her nose. A little girl who has lost everything. Who wants to die so bad I can hardly keep her alive." The tears that had threatened for the last hour finally fell in a steady stream. I forced myself not to look away. "You ain't got to pay the bills for every overnight stay in a hospital, or listen to the bill collectors hound us on the phone. Venetia's got a one-million-dollar lifetime limit on her health insurance and a probable life span of sixty years." She sniffed hard. "I'll be broke and dead long before then."
    Disconcerted, I looked away for a moment. "You're right."
    Mrs. Gordon's eyebrows went up. Her hands, which had continued kneading one another, stilled. Our coffees sat untouched on the desk between us, a curl of steam lifting from each.
    "She initiated the living will?" I guessed suddenly.
    "'Bout drove me nuts till I took her to a lawyer. She wants to die. Can't stand the thought of living like she is. Tonight, jist now, is the first time I seen her laugh in six months." Almera Gordon fished in her neat handbag and pulled out a small, thin pack of tissues. Delicately she blew her nose.
    I remembered the knock-knock jokes the girl had been telling. Had the freedom from extreme fear temporarily reversed extreme depression? I waited until Almera had put away the tissues before resuming speaking. "It's easy for a doctor to get so caught up in potential medical problems that we forget the realities of time and cost." I focused on her bright tear-filled eyes. Her skin was mottled and flushed with the effort of controlling the crying jag. The tissue she still held was already crushed and wilted. "I'm sorry. I know this is hard for you, but we sometimes have to save patients against their will."
    The woman's eyes dropped, but not before I saw tears gather again. She took a shuddering breath.
    "Mrs. Gordon—"
    "Call me Almera."
    I figured that meant I had passed some test in her eyes and I nodded my thanks. "And I'm Rhea." I leaned across the desk toward her. "Almera, Venetia could get this condition at any time. Once someone has had toxic hypertension, it's easier for them to get it a second time. The next time, it could come on her so fast that you wouldn't have time to get an ambulance to her before she had a stroke or expired."
    "Died."
    I nodded. "Died." This woman wanted plain talk. I could give her that. "But it isn't likely that it will happen again tonight, any more than it's likely to happen any other specific time. She's as stable as I can get her in an ER."
    "I'll be taking her home then. I followed the ambulance in my van." Almera stood, straight-backed and resolute, opened the door and stepped out into the hallway. I accompanied her, leaving the coffees on the desk. "I'll stay up tonight watching her," Mrs. Gordon said. "I can check her BP every half hour if I need to." She paused, looking up at me, her face once again hard, eyes calculating. As if to challenge me. "We have an appointment with a faith healer tomorrow. I ain't missing that for nothing."
    My heart fell. I opened my mouth to say that was foolish. To tell her they were all charlatans. Fakes. To tell her that in a few years medicine would have a cure or at least a good treatment for people in Venetia's condition. But I remembered the tears in Almera's eyes and her worry-roughened hands, and kept my mouth closed. The words strangled there. Right now, medicine couldn't provide the kind of help Venetia needed. And the Gordon's needed something to give them hope.
    I settled on, "Would you call us in the morning and let us know how she's doing? We'll be here till seven."
    "I'll do that. And thank you, doctor."
    "Rhea," I said again. But she shook her head.
    "Doctor. And you're a good one. You talk to people."
    With that, she turned her attention to her daughter and getting the girl strapped into her specially made wheelchair. I stood in the ambulance bay and watched as they loaded her up, the gray van situated against a backdrop of vibrant fuchsia clouds and a dying scarlet sun. It was eight-thirty and growing dark, the sunset seeming alive in the dusky sky. I looked up. Not a rainbow to be seen. The cool temperatures wouldn't last. By morning it would likely be back in the high nineties. For now, the false fall was blissful.
    Coreen stood beside me as the van drove off, her wispy brown curls shaded rosy in the light. "They used to go to my church. Now they stay home. Watch TV preachers." The Gordon's van turned onto the road in front of the hospital and moved slowly away, the brake lights glowing.
    In the distance, an engine revved, the whine high and growing shrill as it approached. Headlights rounded the far curve. It was another van, this one vibrant as the sunset, flying up the hill. Foreboding gripped me.
    "That thing's moving too fast," Coreen said. "It ain't gonna make the—"
    The van, silhouetted in the orange sun, made a hard left in front of the hospital. Tires squealed. Its headlights flickered. The van seemed to lift and topple then rolled and disappeared off the road into the ditch. The sound of it hitting earth and the utility pole was like a bomb going off. The pole splintered and flew up into the air. An instant later the impact was over. And I was moving.

copyright ©2013 Gwen Hunter

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