Family Practice Read online

  “Have you put ice on it?”

  “I did but now I’m out of ice, too.”

  “I’ll be there in ten minutes.”

  “I heard. FOOSH?” Zach asked, using the acronym for fall on outstretched hand. He was already moving to the door.

  “No, the window dropped down on her wrist.”

  “Do you want me to come with you?”

  “Yes,” she said honestly, “but it might be faster in the long run if you meet us at the clinic instead.”

  He nodded. “All right. It’s your call, Doctor. I’ll have the X-ray machine ready when you get to the clinic.”

  She wondered if he felt as off balance and shaken by their just-concluded conversation and the kiss that had ended it as she did. If he did, he didn’t show it. She hoped she didn’t, either.

  “Zach, about what just happened...”

  “You’re not off the hook, Callie. Sooner or later you’re going to admit you love me, too, but I’m a patient guy. I can wait. Now we’ve got work to do.” He waved her toward the door and reached into his pocket for his keys.

  Callie led the way into the misty, rain-washed night. She waited impatiently for a break in the stream of cars and golf carts clogging Lake Street and wheeled the Jeep out onto the pavement. Zach did the same, but turned in the opposite direction toward the clinic. Once she was past the business district, traffic thinned out and the drive to the farm was uneventful, although the night was pitch-black and she was careful to watch for the telltale shine of deer eyes along the sides of the road. The security light on her mother’s farm stand guided Callie into the lane that served as a driveway. She parked as close to the house as she could manage and hurried up the gravel walkway to the back porch. The ground was covered with cedar chips from the morning’s tree cutting, and the smell of pine was heavy in the air. She let herself into the house and called her mother’s name.

  “Here I am.” Karen was sitting at the kitchen table, pale and heavy-eyed from weeping. She held her arm high against her chest, her hand and wrist wrapped in an old, soft linen kitchen towel. “What a stupid, stupid thing to do. I tried to wait until morning to call you but it hurts so badly and I can’t move my fingers anymore.” She began to cry. “How will I ever take care of my animals with only one hand?”

  “Shh, Mama,” Callie soothed. “It will be all right. Let me take a look at it.”

  Compartment syndrome. The diagnosis leaped into Callie’s mind. It was caused by crushing injuries to the long bones of the body, which increased pressure within the damaged muscles and cut off blood flow. Untreated it could result in the loss of the limb. One of the presenting symptoms was pain out of proportion to the injury. Maybe she should just bypass taking Karen to the clinic and head straight for the hospital? She wished she’d let Zach come along with her after all. He would decide if she was overreacting. She shook off the jolt of near panic. She could make this diagnosis as well as he could. “Mom, let me check your wrist,” she repeated more firmly.

  Karen moaned, cradling her arm. “It hurts, Callie.”

  “I know. I know.” She held out her hands; reluctantly Karen lowered her injured arm to the table so that Callie could unwrap the towel and remove the plastic bag that had once held ice cubes but now was filled with tepid water. Karen’s hand and wrist were badly swollen, a long bruise across her forearm already turning blue and purple, but the skin was not broken and the bones appeared to be in alignment. Gently, Callie lifted her mother’s middle finger. Karen gasped and cried out loud.

  “Don’t. It hurts.”

  “If you’re in too much pain, we can go straight to the emergency room.” Callie kept her eyes downcast, not letting her mother see how shaken she was.

  “No, I don’t want that. It will take half the night to get there and it’s already late.” She started to cry again.

  “Okay,” Callie said calmly. “Let’s just go to the clinic and get an X-ray. Zach’s already there waiting for us.”

  “Yes,” Karen said, her expression lightening just a little. “Yes, that’s better. I hate hospitals.” She attempted a smile and Callie smiled back. Her mother had always suffered from what her grandmother Layman called “white-coat syndrome.” Hospitals made her very nervous. It wasn’t rational, Callie knew, but it was a common enough phobia.

  “Zach’s your practitioner, so we’ll let him decide if you should go to the hospital, okay? Have you taken anything for the pain?”

  “I made some willow-bark tea,” Karen said. “It didn’t help very much.” Willow-bark tea contained a compound also found in aspirin and had been used as an anti- inflammatory and pain reliever for thousands of years. In Callie’s medical opinion, it didn’t work very well, but she wasn’t about to have that argument with her mother right now.

  “We’ll get you something stronger when we get to town.” Callie grabbed a sweater to throw over her mother’s shoulders and gently got her into the Jeep. Fifteen minutes later, driving as carefully as she could to avoid potholes and rough pavement, she ushered Karen into the small room at the clinic that held the X-ray machine. Zach was waiting for them, looking incredibly handsome with his hunter-orange stethoscope around his neck, a stubble of dark blond beard shadowing his jaw and his hands in the pockets of his well-worn fatigues.

  “You made good time,” he said, catching Callie’s eye for a heart-stopping second before transferring his full attention to her mother. “Have a seat on the stool,” he said to Karen, who was still clutching her injured hand nervously to her chest, “and let me see what we’ve got here.” He smiled reassuringly and dropped to one knee beside the stainless-steel table. He gently examined Karen’s bruised and swollen hand, promising to be as gentle as possible. Callie slipped out of the little room to the medicine cabinet for pain medication and a muscle relaxer while Zach conducted his exam. She didn’t remove the medication from the bottles but set them on a small table by the door with a plastic glass of water. Karen was Zach’s patient; it would be up to him to administer the medication.

  When Callie reentered the room, Zach glanced at the pill bottles and indicated his approval of her choice with a quick nod and a grin. It said more plainly than words that they were working as a team now. “Here’s something to help with the pain.”

  Karen held out the palm of her good hand without an instant’s hesitation, even though she was usually leery of taking medication from big pharmaceutical companies. “Thanks,” she said and swallowed the pills with a few sips of water.

  “We’re going to step into the other room while I get the shots,” Zach explained as Callie draped a lead-lined cape over her mother’s shoulder and abdomen so that only her wrist and forearm would be exposed to the radiation. Then she followed Zach to the control panel behind a short dividing wall equipped with a large pane of glass so that they could see and communicate with their patient while not being exposed to the X-rays themselves.

  When Zach was satisfied he had the right shots, Callie left the protected area and moved to stand beside her mother. Karen laid her head wearily against Callie’s stomach as though she were now the child and Callie the parent. Callie stroked the back of her head where her hair was coiled into a heavy braid. She was wearing a caftanlike robe and leggings, and the hand-knitted sweater Callie had grabbed for her was soft against the palm of Callie’s hand. “Mom, why don’t you go lie down on the couch in the break room? You’ll be more comfortable there.”

  “First let me put a brace on that wrist, Karen,” Zach said, coming up beside them with a soft foam cast. “This will support your wrist and help relieve the pain.”

  “Thank you.” Karen smiled up at him rather dreamily. The pain pill and muscle relaxer were beginning to take effect. “It’s not throbbing quite so badly.”

  “Just what I wanted to hear.” Zach moved her finger again very gently. She winced but didn’t cry out in p
ain as she had before when Callie had done the test. A positive sign. Maybe she had been too pessimistic about the compartment syndrome. She hoped so. “Callie and I will take a look at your pictures and we’ll decide where to go from there.”

  Callie led her mother down the short hall to the break room. The small room was adjacent to the rear entrance of the clinic, and it held a microwave, a coffeemaker and an old leather sofa that someone had donated at some point. Callie helped Karen lie down and found a couple of thin pillows—the disposable ones they used on the exam tables—and a much-washed cotton blanket from the linen cabinet in the hall storage closet. “How’s that?” she asked, placing one pillow behind Karen’s head and positioning the second on her abdomen to elevate her injured hand.

  She laid her good arm over her eyes. “The room’s spinning a bit. I’m feeling a little tipsy.”

  “It’s just the meds. Relax and try to rest.”

  “Callie, how long will I have to wear a cast?”

  “A few weeks, Mom.”

  “How will I take care of the goats? And The Girls?”

  “We’ll work something out. I’m sure the Zimmer boys will be able to give you a hand. And I’m here for you, too.”

  “You have enough on your plate without taking up sustainable-farm living. You never liked that life, anyway.”

  “That’s true enough,” Callie conceded with a grin. “But it doesn’t mean I can’t do it.”

  Karen gave a little sniff. “And my spinning and knitting? Oh, dear, what if it doesn’t heal right and I can’t do handwork anymore?”

  Callie knelt beside the couch and patted her mother’s shoulder. “Don’t get ahead of yourself. If need be, Zach and I will consult with the orthopedists at the hospital. Your hand will be fine.”

  “Are you sure?”

  “Positive.”

  “Very well, Dr. Layman,” she said and sighed contentedly. “I like the sound of that. Dr. Layman. Have I told you that before? Have I told you how proud I am of you? My beautiful daughter, the doctor. Every mother’s dream.”

  “Yes, you have told me, but beautiful is going a little overboard,” Callie said, smiling at her slightly rambling compliment.

  “It certainly is not,” Karen insisted but her voice slurred a little on the last words. “You are lovely.”

  “That’s the meds talking.”

  “That’s your mother talking,” Karen said firmly.

  “I won’t be a minute,” Callie promised. She dimmed the lights as she left the room and hurried to the X-ray room. Zach had the pictures already clipped to the light board as well as on the flat-screen computer monitor in front of him. “How bad is it?” she asked, her eyes going to the larger image.

  “Clean break,” Zach said, indicating the thin, dark line across the ulna, the long bone of the forearm. “The bones are in alignment. The fracture should heal without any complications.”

  “Are you sure? I was afraid it might be compartment syndrome. She was in so much pain. She couldn’t move her fingers.”

  “She’s got a nasty bruise, but I don’t think the damage is serious enough to produce compartment syndrome. It’s usually a result of a far more traumatic injury in an acute form—car accidents, explosions, things of that nature.” His tone suggested he had encountered such injuries in combat situations. She nodded, deferring to his greater experience. “She’s never shown any indication of chronic compartment syndrome, has she? Swelling, numbness, transient paralysis.”

  Callie shook her head. “No, nothing like that.”

  “Then I think we’re safe in ruling it out.”

  “Those windows are really heavy and Mom has a small frame for her weight.” Callie voiced her last reservation.

  “I’ve got a call in to the hospital. Someone will be on call in Orthopedics. The camera’s up and running on the new system. We’ll get a consult.” All the while they’d been talking, Zach had been keying in his notes on Karen’s injury and treatment. She watched his long, strong fingers at work and marveled at how gently he had held and manipulated her mother’s injured hand. So many contrasts to this man. Strength and gentleness. Dark and light. Would she ever understand him well enough to anticipate his moods, read his emotions as some longtime partners, as married couples, sometimes seemed to be able to do? It was a tantalizing scenario.

  The computer chimed an incoming call from the hospital’s network. Zach closed out Karen’s chart and keyed in the clinic’s password. The screen went dark for a moment and then a tired but pleasant-faced man of middle age appeared on a split screen. The other side of the screen showed Karen’s X-rays. “Zach, good to see you. What can I do for you?”

  “Dr. Assad. I didn’t expect you to be on call on a Saturday night.” Zach’s smile was wide and genuine. Ahmed al Assad was the head of the orthopedics department at the Petoskey hospital. Callie knew of him, but she’d never met the man in person.

  “I got called in for an emergency this afternoon and haven’t been able to get away again. We’re swamped here tonight—a couple of ATV accidents and a senior who fell down her apartment steps and broke her hip. And it’s not even midnight. Who is the lovely lady beside you?”

  “Our new physician in charge. Dr. Callie Layman, may I present Dr. Ahmed al Assad.”

  Callie moved into range of the computer’s small camera lens, just inches from Zach’s face. She tried not to be aware of his warmth and the clean, masculine scent of him. He was so close, all she had to do was turn her head slightly and she could kiss his ear. “It’s a pleasure to meet you, Doctor.”

  “The pleasure is mine, Dr. Layman. Rumor has it you are considering becoming a permanent member of our team.” His accent was decidedly British, although Callie knew he was Canadian by birth.

  “I’ll be making my decision soon, Doctor.” Dr. Assad was a member of the hospital board of directors. The Physician’s Committee had to keep the governing body apprised of their plans and must have informed the board of their offer to her. She wondered how many other staff members had heard about the offer before she had. Several, at least, she supposed.

  He pulled a pair of half-glasses from the pocket of his white coat and set them on his nose. “Want to give me the details on your patient, Zach?” He listened closely as Zach recited Karen’s vital statistics and described her injury, nodding as he continued to study the images he was viewing. “Your diagnosis is spot-on, as usual,” he said as Zach finished speaking. “Clean break, it appears to me. Could have been much worse if the window had caught her a few centimeters closer to the distal radius. There are as many treatment options for this kind of injury as there are physicians to treat them. I’m old-school, you know. Make sure the bones are in alignment, continue the meds as required, immobilize for four to six weeks and then some intensive physical therapy. Bring her in Monday. That will give us some time for the swelling to go down before we repeat the X-ray and cast it permanently. Unless you want to make the trip tonight? I am not going anywhere.”

  “I think it will be better for my mother to rest in her own bed tonight, Doctor,” Callie said, ignoring the offhand manner of his pronouncements. It was a common enough injury, after all, and he was a highly trained surgeon; arrogance came with the territory.

  “The patient is your mother?”

  “Yes, Doctor.”

  “Callie’s mother doesn’t like hospitals,” Zach said with a grin. He was as adept at dealing with high-strung surgeons as he was with nervous middle-aged women and small children.

  Dr. Assad nodded. “Call my office first thing Monday morning, Dr. Layman, and we’ll work her in after lunch,” he promised, proffering a consult as a professional courtesy.

  “Thank you.”

  “No thanks necessary, Doctor.” Assad gave the screen a wolf’s grin. “Anything else I can do for you, Zach?”

 
“That’s all for tonight, Doc. Thanks for the second opinion.”

  “A pleasant night to you both.”

  “Good night.” Callie smiled her farewell, but instead of ending the call, the surgeon leaned back in his chair and laced his hands behind his head.

  “How much longer are you going to be in exile down there in White Pine Lake, Zach, especially now that they’ve got someone to take your place?” His tone was friendly but nonetheless carried an undercurrent of interest that wasn’t lost on Callie.

  “I’ve got a year and a half to go on my contract,” Zach said, but he had suddenly gone very still and she could sense he didn’t want to pursue the topic.

  “Doesn’t your contract include automatic opt-outs every six months? I’m positive Parsons told me something of the sort,” Dr. Assad probed, his grin disappearing completely. “Surely you aren’t planning to be away from here for that long? Hasn’t Parsons been in touch? He’s going to be taking that position at the University of Michigan before the end of the year. Don’t tell me you’re going to pass up making the move with him?”

  This time it was Callie who stiffened. Zach had told her nothing about the opt-out clauses. Nothing about an offer from Parsons, the hospital’s hotshot neurosurgeon who was heading to Ann Arbor to set up a practice associated with the medical school’s world-famous neurosurgical program. It would be a prestigious posting for Zach.

  “Dr. Layman, help me out here,” the orthopedist said genially. “Zach’s on the fast track with Parsons. You’ve worked with him for what? Six weeks now?”

  “A little less than that.”

  Assad waved his hand in dismissal of the technicality. “Surely you agree he’s wasted setting broken wrists and conducting high-school physicals and scolding overweight seniors about their cholesterol numbers. If I had my way, I’d talk him into going to medical school. He’s underutilized as a PA.”

  “Med school’s not for me,” Zach said, as if that simple statement settled the argument. But Callie was close enough to him to sense the sudden tension in the muscles of his neck and shoulders. Why hadn’t he said anything about this offer? He’d never mentioned it, never hinted at it. Was that why he hadn’t helped her make her own decision about staying on in White Pine Lake, because despite what he said about falling in love with her, he was going to leave her here and make a new life for himself three hundred miles away?