“Dana Marks, twenty-three years old, presenting with abdominal pain and significant weight loss since Wednesday. Some hair loss. No history of abdominal disease or heart problems, no previous abdominal surgeries, no previous abdominal exams.”
Dr. Hayes pulled up the image I’d just taken, and squinted his eyes for a moment. “How significant?”
“Nineteen pounds.”
He looked only slightly impressed until the image appeared on the screen. He blanched. “Oh my God.”
“I know.”
“Where has she been?”
“She hasn’t traveled recently, if that’s what you mean. She did mention being attacked by a drunk after a party Tuesday night.”
“This is profound. Do you see the ring of gas here?” he asked, pointing to the screen. His eyes brightened with recognition. “Portal venous gas. Look at the biliary tree outline. Remarkable.” Dr. Hayes went from animated to somber in less than a second. “You don’t see this very often, Scarlet. This patient isn’t going to do well.”
I swallowed back my heartbreak for Dana. She either had a severe infection or something else blocking or restricting the veins in her bowel. Her insides were basically dead and withering away. She might have four more days. They would probably attempt to take her to emergency surgery, but would likely just close her back up. “I know.”
“Who’s her doctor?”
“Vance.”
“I’ll call him. Cancel the UGI. She’ll need a CT.”
I nodded and then stood in the hall while Dr. Hayes spoke in a low voice, explaining his findings to Dr. Vance.
“All right. Let’s get to it,” the doctor said, standing from his chair. We both took a moment to separate ourselves from the grim future of the patient. Dr. Hayes followed me down the hall toward the exam room where Dana waited. “The girls doing okay?”
I nodded. “They’re at their dad’s this weekend. They’re going to meet the governor.”
“Oh,” the doctor said, pretending to be impressed. He’d met the governor several times. “My girls are coming home this weekend, too.”
I smiled, glad to hear it. Since Dr. Hayes’s divorce, Miranda and Ashley didn’t come home to visit nearly as much as he would have liked. They were both in college, both in serious relationships, and both mama’s girls. Much to the doctor’s dismay, any free time they had away from boyfriends and studying was usually spent with their mother.
He stopped, took a breath, held the exam-room door open, and then followed me inside. He hadn’t given me time to set up the room before he came back, so I was glad the upper GI was cancelled.
David was shaking the bottles of barium.
“Thanks, David. We won’t be needing those.”
David nodded. Having seen the images before, he already knew why.
I helped Dana to a sitting position, and she stared at both of us, clearly wondering what was going on.
“Dana,” Dr. Hayes began, “you say your problem began early Wednesday morning?”
“Yes,” she said, her voice strained with increasing discomfort.
Dr. Hayes abruptly stopped, and then smiled at Dana, putting his hand on hers. “We’re not going to do the upper GI today. Dr. Vance is going to schedule you a CT instead. We’re going to have you get dressed and go back to the waiting room. They should be calling you before long. Do you have someone with you today?”
“Joey, my boyfriend.”
“Good,” the doctor said, patting her hand.
“Am I going to be okay?” she said, struggling to sit on her bony backside.
Dr. Hayes smiled in the way I imagined him smiling while speaking to his daughters. “We’re going to take good care of you. Don’t worry.”
I helped Dana step to the floor. “Leave your gown on,” I said, quickly grabbing another one and holding it behind her. “Slip this on behind you like a robe.” She slipped her tiny arms through the holes, and then I helped her to the chair beside the cabinet. “Go ahead and put on your shoes. I’ll be right back. Just try to relax.”
“Yep,” Dana said, trying to get comfortable.
I grabbed her requisition off the counter and followed the doctor to the workroom.
As soon as we were out of earshot, Dr. Hayes turned to me. “Try to talk to her some more. See if you can get something else out of her.”
“I can try. All she mentioned out of the ordinary was the bite.”
“You’re sure it wasn’t an animal?”
I shrugged. “She said it was some drunk guy. It looks infected.”
Dr. Hayes looked at Dana’s abnormal gas patterns on the monitor once more. “That’s too bad. She seems like a sweet kid.”
I nodded, somber. David and I traded glances, and then I took a breath, mentally preparing myself to carry such a heavy secret back into that room. Keeping her own death from her felt like a betrayal, even though we’d only just met.
My sneakers made a ripping noise as they pulled away from the floor. “Ready?” I asked with a bright smile.
Chapter Two
Scarlet
BY LUNCH, DANA HAD ALREADY BEEN IN AND OUT OF surgery. Christy told us they only opened her up long enough to see there was nothing they could do, before closing her back up. Now they were waiting for her to awaken so they could tell her she would never get better.
“Her boyfriend is still with her,” Christy said. “Her parents are visiting relatives. They’re not sure they’ll get back in time.”
“Oh, Jesus,” I said, wincing. I couldn’t imagine being away from either of my daughters in a situation like that, wondering if I would make it in time to see her alive one last time. I shook it off. Those of us in the medical field didn’t have the luxury of thinking about our patients’ personal lives. It became too close. Too real.
“Did you hear about that flu?” Christy said. “It’s all over the news.”
I shook my head. “I don’t think it’s a flu.”
“They’re saying it has to do with that scientist over in Europe. They say it’s highly contagious.”
“Who are they? They sound like troublemakers to me.”
Christy smiled and rolled her eyes. “They also said it’s breached our borders. California is reporting cases.”