Kate shook her head.
“Fevers? Night sweats? Trouble going to the bathroom?” Another head shake. “Aches, pains?”
“My leg.”
“Tell me about it.”
Katie pointed to her left leg directly below her knee. “It started about a month ago. It hurts if I press it.”
“Does it ever hurt on its own?”
“Sometimes.”
“Has it gotten worse?”
“I’m not sure. But Dad said we should see you because it hasn’t gotten better.”
Allison applied moderate pressure with her thumb. Katie winced. “Tender.” Allison observed.
“It’s not bad. I’ve been able to play through it.”
Allison massaged the joint. She felt nothing amiss structurally. She noticed a bruise. “Did you get kicked here?”
“Of course,” Katie laughed. “And everywhere else.”
Allison had Katie dangle her legs over the edge of the table and thwacked her left knee with a rubber-headed hammer. Katie’s leg shot forward. She repeated the test on the right leg with the same result. “Reflexes normal,” Allison said. “Could you have injured it any other way?”
“Maybe. It started hurting a few days after I jumped out of a tree.”
Allison compared Katie’s right leg to her left. She found no apparent differences. “What were you doing in a tree?”
“Getting a soccer ball that got stuck up there.”
“How high did you jump from?”
“Not very high.”
“Higher than you are tall?”
“Yeah.”
“But you don’t remember your leg hurting when you landed.”
“No.”
Allison considered the possibilities. Katie’s mobility wasn’t compromised, so she felt she could rule out a tear of the meniscus as well as damage to either of the collateral ligaments—good news since both injuries often required surgery and could be career-ending. A torn or strained muscle was similarly unlikely. That left two obvious culprits: bleeding between the leg bone and the periosteum—a deep bone bruise in layman’s terms, likely the result of being kicked above the shin guard—or a stress fracture, perhaps from so much soccer, perhaps from jumping from the tree. Unlike a regular fracture, the precipitating event for a particular stress fracture could rarely be determined.
Bone bruises were painful but generally required no treatment. Stress fractures were another matter, usually requiring at least a month of limited activity. A stress fracture would mean no soccer.
Allison leaned toward the bone bruise diagnosis. The pain from a stress fracture was likely to be more constant than the occasional symptoms Katie had reported. That she had noticed the pain after jumping from the tree was likely coincidental, although the jolt could have aggravated the bruise. But she couldn’t be sure.
“Probably a bone bruise,” she told Katie. “Once you stop getting kicked in the shins every day, I suspect this will take care of itself. But I’m going to take an x-ray, just as a precaution.”
“I can still go to camp though, right?”
“I’ll clear you for camp, pending the x-ray. You’re not going to damage it if it’s a bone bruise. If it starts to hurt more, just stay off it for a while. Ice every day. And don’t jump out of trees.”
“But I like to climb trees.”
“Then try climbing down the tree after you’ve climbed up it.”
Katie gave her a grin and slid off the table.
“Not so fast,” Allison consulted Katie’s file. “You’re due for a tetanus shot.” Katie made a face. “I can’t sign the camp form without it.” Katie sighed. Allison administered the booster and took the leg x-ray. When they were done, she escorted Katie to the waiting room where Josh stood reading the bulletin board.
Allison had hardly seen him since Sharon’s death. Sharon had been their link and the link had been broken. The limited contact was probably merciful, she decided. Sharon would have been the topic of conversation. The wound was still too raw for both of them. The loss of a young woman, a dear friend, of her own age was real enough for her. She couldn’t imagine what it was like for Josh. Still, she found herself happy to see him. He looked stronger than the grief-ravaged husband he had been at the end and he positively lit up at the sight of his daughter.
“Katie looks fine,” she reassured Josh. “I gave her a tetanus booster and took a precautionary x-ray of her leg but I don’t expect to find a problem.” Allison made a point of looking directly at Josh and at his daughter, acknowledging the girl’s status as a full participant in the conversation about her own well-being.
“That’s good news,” Josh said. “How about the permission slip?”
Allison knew her own father—an unwavering stickler for doing things by the book—would never have signed the camp form without the results of Katie’s x-ray. But she had adopted a more flexible approach that started with: Do what’s best for the patient. “Sure,” she said. “It’ll save you a trip.” She signed the form and handed it to Katie. “If I see anything on the x-ray, I’ll let you know.”
When they were gone Allison removed her lab coat, collapsed into the black high-backed leather chair behind her desk, and slipped off her shoes. She was starting to unwind when Coretha Hall, her nurse assistant, entered and plopped an armload of files on her desk. Allison stared at them. “Tell me again why I wanted to be a doctor?” she sighed.
Coretha laughed. “Your father used to sit right there and say the same thing. He just hated the paperwork.”
Allison flipped her hair over the back of the desk chair. “What did you tell the old man?”
“I’d say, ‘Dr. Wright, you were young and naïve. You must not have known what you were getting into.’”
“I suppose I can’t use that excuse.”
“No,” Coretha agreed. “For as long as you dilly-dallied around, I’d say you can’t.”
Coretha was, Allison decided, equal parts compassion, humor and no-nonsense. Perfect for a nurse. In that way, she reminded Allison of her mother. It made sense since both women had served the same demanding man—her father—for much of their lives.
Coretha’s dark skin contrasted with her white cotton nurse’s uniform. Oversized bright red glasses hung from a cord around her neck. She lifted them to the end of her nose and looked at her watch. “Quitting time,” she announced.
“You go ahead.” Allison waved at the files on her desk representing the day’s cases. “I’ve got paperwork.” She grabbed the file of Ricky Scruggs. “People don’t understand piercing is surgery,” she said. “You can’t use equipment that hasn’t been sterilized.”
“That what caused his problem?”
“Odds are. He did it himself.”
Coretha shuddered. “You wouldn’t catch me doing that. Is that what happened to the woman with the earlobes?”
Allison replayed her mental tape until it got to the prior week and the small, mousy woman with scraggly hair, her earlobes hot with infection that spread in flaming spikes across her jaw and down her neck. She hadn’t thought of her when Scruggs showed up and she decided there was no reason she should have.
“The woman had her ears pierced years ago, not recently. Interesting coincidence