“No, Josh shouted, “You can’t. That’s not just another case in the room back there. That’s my daughter. Got it? Mine. So I make the decisions. Not you. Me.”
But for a knock on the conference room door, Josh might have slugged him. A nurse poked her head in. She looked first at Josh, then the doctor. “Everything okay?”
“Fine,” Josh croaked. No wonder the nurse had come running. He must have been shouting to high heaven.
“No problem,” said Pepper.
The nurse left. Pepper slumped in his chair. After a minute, he said, “I shouldn’t have yelled. I apologize. Sometimes I forget that when a kid is sick, the parents are patients, too.” He pushed his glasses to the top of his head, and sighed. “How’s your wife doing with all this?”
“She’s dead. She doesn’t feel a thing. Two years ago. Breast cancer.”
“Oh Christ.” It emerged as a single word. “I’m so sorry for . . . everything. I didn’t know you had a history.”
“Of defeat.”
“I have faith we can make this one turn out differently.”
Josh remembered how it had been with Sharon—the constant worry, the clinging even to the faintest hope, and the endless rounds of chemo followed by sickness and suffering. And finally death. Since then, faith was something he’d done without. Facts were what counted, answers what he needed. “I need to make a phone call,” he said.
“Of course. Have the nurse find me when you’re done.”
Pepper was barely out of the room before Josh was on the phone to Allison. “This guy’s screwed up,” he said, pacing. “I don’t think he knows what he’s doing.”
“His reputation is one of the best in the business.”
“Then I’d hate to see the worst. We haven’t done any tests but he’s pushing me to admit Katie today.”
“If she’s sick, the clock is ticking.”
“Her soccer camp starts Saturday.”
“Let’s cross one bridge at a time. Have them do an MRI and bone scan. They’re relatively fast, painless and I predict it’ll tell us that whatever’s in the leg hasn’t spread. Follow that up with a core needle biopsy. It’s going to hurt some but she won’t have to be admitted and it’ll tell us if it’s cancer and what kind. They’ll have the results in a few days. We’ll figure out soccer camp from there.”
“Will do.” Josh hung up, called the nurse and sat at the conference table. Pepper arrived a minute later.
“You have a remarkable daughter. She’s very mature for her age, very grounded.”
“She hasn’t had much of a chance to be a kid.” Seated, Josh felt like he was begging. He stood so the two men looked eye-to-eye. “Pepper, here’s the deal. Do an MRI, a bone scan and a needle biopsy. If there’s no cancer or if it hasn’t spread, she goes to camp. If there is cancer, I’ll bring her directly here at the end of camp.”
“No,” Pepper said. “She goes to camp only if she’s clear.”
Josh decided to let the matter drop. With any luck, it wouldn’t be an issue. He paced in the waiting room while Katie, dressed in a hospital gown adorned with the children’s hospital mascot giraffe, was pushed off for her MRI in a wheelchair. He caught his next glimpse of her through an open door ninety minutes later as she rolled by on a gurney, covered to her neck by a green sheet. A tube ran from a plastic bag suspended over the gurney to a needle in her left arm. A nurse walked alongside.
Josh sprinted into the hallway and caught up. The gurney kept moving. Josh kept pace. He took Katie’s hand. “Hey, sweetheart. How’s it going?”
“Fine. The hardest thing was staying still. But they gave me headphones so I could listen to music.”
Josh caught the nurse’s eye and nodded to the bag. “What’s that?”
“Technetium ninety-nine. It’s a tracer that accumulates in damaged bone so it shows up on the gamma camera scan.”
“It’s radioactive,” Katie volunteered from the gurney.
“It is,” the nurse confirmed. “Perfectly harmless. Half life of about four minutes. Got to keep moving.”
Josh dropped back as the gurney picked up steam.
He insisted on being present during the needle biopsy. Katie lay on the gurney, only her face exposed. A nurse pulled back the green sheet, swabbed the leg with Betadine and secured it with a Velcro strap. Josh took Katie’s hand. An orthopedic surgeon appeared, selected a syringe from a tray, palpated the area just below Katie’s knee, and gently inserted the needle. Josh winced. Katie looked the other way. The surgeon removed the needle a few seconds later.
“That’s it?” Josh said hopefully.
“That’s lidocaine. We’ll let it freeze this knee and be in and out in a flash.” The surgeon began to hum “Frosty the Snowman.”
He reached for another needle, this one much larger than the first. “Fourteen gauge should do it,” he mused. He slid the needle into the flesh just below Katie’s knee.
Katie cried out, “Dad, you’re hurting me!”
Josh realized he had Katie’s hand in a death grip.
The surgeon withdrew the needle. Josh heard a click. The surgeon plunged the needle in again.
“Pfizer man’s here.”
Allison marked her place in the Atlas of Dermatology. Coretha stood in her door. “Skip the Viagra samples but get as much of the Lipitor as you can.”
“You told him last time you’d eat lunch with him.”
Allison groaned. Drug company sales people made a practice of providing lunch to busy physicians and their office staffs just to get a few moments to talk with them about the latest wonder drug and to leave samples. In many offices, it was a tradition—the Pfizer man on Mondays, the Merck woman on Wednesdays and so on. The Winston Medical Clinic had few pharma callers and Allison couldn’t have cared less about the ones who did show up. But samples allowed her to provide medicines to her many patients who could not afford them. Lunch with the drug rep came with the territory.
At the moment, however, she couldn’t even think about eating. She’d almost vomited when she removed the sock of fifty-eight-year-old Wanda Faggart, her first patient Monday morning. The putrid smell of the black, oozing, gangrenous fourth toe on her right foot still clung to her nostrils. On top of that, the call from Josh in Columbus had left her stomach churning.
“Apologize to him for me. And don’t forget to get the Lipitor.” Allison returned to the medical text and found a section dealing with what she had observed in Faggart: a large necrotic ulcer with overlying exudate and surrounding erythema, edema, and eschar formation.
But what had caused the death of the tissue? She turned to her computer and searched her medical sites for causes. There were plenty, from vasculitis to streptococcal infections to a dozen different syndromes and phenomena. But occurrences were extremely rare. In all her prior practice, she’d never seen a single case where the cause wasn’t immediately apparent. Now, within days, she’d seen three cases of tissue death in otherwise healthy people. Scruggs’s nipple ring involved a piercing. He had done it himself. Streptococcal bacteria on the instrument was the presumed cause. In the case of Faggart’s toe and the woman with the infected ear—Audrey Pringle, according