Chapter 1
Patient Love
Lying among the
crumpled sheets on a hospital bed, the dying man gasped for air. Stretching a
trembling hand into the air above him, Joe Blevins struggled to focus his
clouded eyes on the familiar face of the smiling, be-speckled doctor peering
down toward him. The words came hard, pushing through gasps of air.
“Please. Doc
Briggs. Help. Me. I. Have. Never. Been. Sick. I am only 63 years old.” His
chest heaved, and with each exhale, the haggard face deflated.
With a
consoling pat on Joe’s shoulder, Dr. Nicholas “Briggs” Oxenbriggs slowly
increased the drip on the IV that traced down to the man’s withered arm.
“Joe, I love
you. You are my favorite patient. I will take good care of you, my friend, good
care.”
Dr. Oxenbriggs
pulled a slender syringe from the breast pocket of his crisp, white hospital
jacket, and in one calming move, he pushed the clear contents of the cylinder
into a port on the IV line. He carefully lowered Joe’s extended arm to his
side. “It’s okay, Joe. This will help. I assure you. I love you.”
Briggs stepped
back, cocked his head from side to side, watching like a cat waiting for a
trapped mouse to move. Joe struggled, gasped, shuddered, then finally convulsed
and fell backward. Silent. Dr. Oxenbriggs leaned over his now dead patient,
raised Joe’s left hand, and removed the diamond-studded ring from his limp
pinky finger. Studying it for a moment, Dr. Oxenbriggs dropped the glittering
hoop into the breast pocket on his lab coat. For a moment, the tall, muscular
doctor with greying salt and pepper hair rubbed his patient’s placid face, and
then with a sigh, he said, “I loved you, Joe, and you are much better off now.”
Dr. Oxenbriggs
patted the ring resting in his jacket pocket. “I will always have you with me,”
he whispered.
Leisurely, he
pulled the emergency call button, then yelled urgently into the speaker.
“Code Black.
Code Black. This is Dr. Oxenbriggs. Code Black. STAT!”
Almost
instantaneously, the emergency team of nurses, assistants, and medical
residents shoved into the room at the Lone Mountain Medical Center in Big Stone
Gap, Virginia. They found Dr. Briggs frantically pressing his hands into the
dead man’s chest, performing CPR on the lifeless body of Joe Blevins.
“Hurry! I’m
losing him. Joe! Joe! Stay with me!” Dr. Oxenbriggs ordered the bevy of nurses,
medical residents, and assistants who quickly moved into action. No one seemed
to notice that the heart monitors had long-since stopped beeping.
After a while,
Briggs said softly, “Call it.” Another voice responded, “Time of death,
o-eight-hundred.”
Briggs stood,
staring at the body of the man who had been very much alive just a few moments
before. He rushed forward and gathered Joe’s body into his strong arms. He
wept. “Joe, you cannot be gone.”
Several members
of the team tried to pull the doctor back, but he jerked away. Soon, he
reluctantly and gently laid the body onto the bed. Briggs shook his head, wiped
his face, straightened his lab coat, and wiped a single tear from his cheek.
“I’ve done all
I could, all I could. He was my favorite patient. Can someone call the family,
please?”
Two of the
medical assistants reached out to console Dr. Oxenbriggs, but he jerked away
from their touch, turning to rest his hands on their shoulders instead. “No
need. No need. I’m more concerned about Joe and his family,” Briggs choked back
a sob and moved toward the door. Before he pushed out into the hallway, he
turned to one of the residents.
“Sign the death certificate, please? I need to
be alone for a moment.”
All except one
member of the team watched reverently as with one long sigh, the grand doctor
strode out of the room into the bright bustle of the hospital corridor. Once
out of view of the room, Dr. Oxenbriggs patted the breast pocket of his
starched-white lab coat and smiled. “I loved you, Joe. You’ll be with me
always.”
The doctor who
hung back was Dr. Ash McKay, who did not give way to the worship of Dr.
Oxenbriggs. He remained quietly standing in the darkest corner of the late Joe
Blevins’ hospital room, entertaining an uncomfortable, nagging suspicion. As
chief resident and top Fellow in the Community Medical Care Program that Dr.
Oxenbriggs headed at Lone Mountain, McKay often stood alongside Briggs when he
saw patients. McKay had been the first to respond last week when they lost
another elderly patient.
In that case as
well, when the team responded to Dr. Oxenbriggs’ call for help, they found the
great physician frantically performing CPR on Mrs. Sarah Madison. In what was
an almost identical display, Dr. Oxenbriggs had struggled heroically to will
the elderly woman back to life. He had sobbed that he loved her. He mourned
that he had lost his favorite patient. He stood over the body and wiped away
tears. The scene was all too similar for the analytical Dr. McKay. He had no
evidence, but the voices telling McKay something was wrong roared rather than
whispered.
Last week’s
patient was a 77 year-old mother and grandmother, Sarah Madison. She had raised
10 children alone in the tiny community of Josephine, just outside Norton,
Virginia. Set in the shadows of the Blue Ridge Mountain chain that enveloped
most of Wise County, Josephine had once been a thriving train stop with some
homes, a church, a store, a post office, and even a one-roomed school. By the
time Sarah found the place, all that remained were the fading remnants of the
one-roomed schoolhouse, the church, and a limestone train depot that stood
defiantly on the edge of the weedy, rusted railroad tracks.
What most
people thought of as abandoned, Sarah saw as a home for herself and the
children. Her husband died in a mining accident in 1960. The union benefits
helped, but they did not put a roof over Sarah’s head, and the money didn’t buy
food for the table. Sarah couldn’t find work in those days. She had been
walking home to the rented house up in the holler when she passed by the tiny
sign that said, “Josephine.”
Something drew
her to the overgrown site. She walked along the remnants of the dirt road that
led to the train station. The weeds dragged against her skirt. The briars
nicked her legs. Once, she looked at the thicket surrounding her and thought
about snakes. Copperheads were not uncommon, and this was the season for them.
She stepped more carefully, making her way to the train station, which still
stood defiantly as if it were a sentry guarding the site against the
encroaching weeds and overgrowth. Sarah peeked inside the broken glass.
Something scurried along the floor. That didn’t scare her. From what she could
see, the structure appeared sound. Sarah stepped back and scanned the entire
area.
It needed work.
She was not afraid of that. She and her children could turn this place into a
home. She walked around, envisioning a future here. She stooped down and picked
up a handful of dirt. The soil felt silky and rich. Good for corn. Where weeds
and saplings grew, Sarah saw rows of green corn bending softly to a gentle
wind. Where green kudzu covered the train station, Sarah saw a clean limestone
home with a red door and grey front porch. Where there stood nothing more than
emptiness, Sarah saw a manicured lawn filled with the delightful laughs of
children—her children.
She didn’t ask
anyone if she could move into Josephine. Sarah figured that it had long ago
been abandoned, so no one cared. She was almost right. For the next several
years, Sarah and her children cleared the land together, rebuilt the floor in
the train station, planted a garden, and eventually bought a cow and some
chickens. They created a fence around the old store and turned it into a
milking barn and chicken coop. She made this once ghostly place a true home
that protected and loved Sarah and her family for nearly 50 years.
After she and
her children had been in Josephine for nearly a decade, they were visited by a
man who claimed that he owned the property. He told Sarah that she would either
have to pay rent or leave. Normally suspicious of authorities and afraid of
losing her only home, Sarah asked for some time to think about her options. The
man gave her one week.
Sarah’s oldest
son, who was now in his 20’s and preparing to go into the military, offered to
talk to his recruiting officer in Kingsport. That turned out to be the best
idea in the universe as far as Sarah and her family were concerned. The
recruiting officer guided Sarah’s son to the court records. Through that, he
learned that the man was lying. The land had been abandoned years ago. If Sarah
worked with the county to pay the back taxes, she would own the land outright.
It took another five years, and with the help of her now grown son and
daughter, Sarah and her family earned the deed to the land.
Until a fall
forced her to hobble about on crutches, Sarah Madison kept Josephine alive for
a growing family that now included a dozen grandchildren and couple of great
grandchildren.
“Strong
mountain grit,” her oldest daughter had described her mother. “She had to do
all the repairs, raised us, and worked as the cook in the elementary school
down in Big Stone Gap to bring in a little money.”
Probably
because of her hard-scrabble life, Sarah never suffered the diseases common to
most of her mountain neighbors—heart disease, diabetes, high blood pressure, or
depression. Yet, within a month after that short fall inside her home sent her
to the hospital, Sarah began to hallucinate. She suffered two minor strokes,
convulsions, became very forgetful, and finally, she could not swallow. Food
particles trickled into her lungs, and in the end, the once vibrant woman lay
nearly motionless in a hospital bed—a heap of heaving bones and skin. She died
in a room at Lone Mountain Medical Center while all her children and
grandchildren had gone home to rest.
Even the
passionate skills of Dr. “Briggs” Oxenbriggs had failed, and the staff’s
admiration of Briggs solidified when they witnessed him surreptitiously wiping
a tear outside Sarah’s hospital room.
Briggs
counseled Ash following Sarah’s death. “Sometimes the elderly person innately
knows death is coming and does not want their family to live with those
memories. Therefore, the dying person somehow summons the will to pass when
none of their loved ones are present. You do all you can and then know people
like Sarah are at peace—out of the pain, the struggle, the hurt.”
McKay didn’t
subscribe to that theory. He considered himself a scientist whose primary area
of research was the human body. He had little faith in anecdotal or empirical
evidence—only that which could be proven, and preferably after double-blind,
peer-reviewed research studies to verify the results.
Now, recalling
the two scenes, a stubborn hunch protruded from the deep recesses of Ash’s
analytical mind. He tried to push the idea out—negate it because there was no
factual basis. Yet, the notion would not abate. Could it be that his boss, his
mentor, his reason for choosing the Community Medical Care Program, the
unrivaled Dr. Nicholas “Briggs” Oxenbriggs had just staged some grand emotional
pageant for his staff to witness? But to what purpose? There was no evidence of
anything other than the fact that Dr. Oxenbriggs had worked valiantly to save
two patients. All Ash had was a weird, unwanted thought that he willed himself
to ignore.
Meanwhile, in
another hospital room down the hallway, Eliot West paced in front of the
hospital bed, where his father, Ira, sat and watched. Beside him sat Eliot’s
mother, Etta, gently holding Ira’s hand. She kept a keen eye on her husband for
any signs of another stroke. Meanwhile, Eliot could not be still. In his
mid-thirties, Eliot’s compact, muscular frame looked more like that of a body
builder than a police officer.
“Son,” Ira
said, “Please sit down.”
“Dad,” Eliot’s
raspy voice contradicted his nervous movements. “We’ve been waiting a long time
since they brought you up here from the ER.”
As he moved,
the black handle of his handgun jutted out beneath his brown leather jacket.
Ira, whose eagle eyes never missed a thing, saw the weapon.
“Son, how did
you get that gun in here? There are rules, even for cops, you know,” Ira
chided. A wry smile crossed Ira’s pale face. He was an older, greyer, and
slightly thinner version of his son. “But sit down, please. You’re going to
cause me to have a stroke.” Ira smiled broadly.
“You’re not
funny.” Shaking his head of shoulder-length brown hair and pushing his eye
glasses back onto the top of his head, Eliot flopped into the black recliner
across from the hospital bed. He could not stop fidgeting, glancing from the
door to the room and back to his father.
“May as well laugh,” Ira spread his free arm
and kissed Etta on the head. “After all, laughter,” he began, and Etta and
Eliot chimed in.
“…is the best
medicine.”
“Okay, you win,
Dad,” Eliot stretched to his full height and forced himself to sit still.
Looking to
Etta, Ira warned her. “Mamma, I will be home in time, so don’t you even think
about packing that truck by yourself.”
Petite, with
short, dark hair and a round, pug-nosed face and two deep, brown eyes, Etta
West gave her husband a look of astonished anger. “Ira, we are not going to
Michigan. I’ve already called your brother to tell him.”
She stood
beside the bed, stretching to her full five-foot-five height, and began to
fluff Ira’s pillows, moving him as necessary. Smiling all the while, he
accommodated her fussing over him.
“Etta, honey,
this was a mild stroke. As you can see, I’m perfectly fine, and I want to see
my brother. With that cancer he has, there isn’t much time.”
Etta adjusted
the white sheets and soft, blue blanket around her cheerfully-compliant
husband. Over their 40 years of marriage, Ira had come to one conclusion: Etta
wins every time. He loved her so much that he never wanted to be the cause of
any pain or distress for her. Theirs had been a relationship that defined the
word “cherish.” Eliot watched them for a long moment, wishing his own marriage
had been more like his parents, trying to discern what they did right and what
he failed to do.
He had met his
wife, Rhett, in Knoxville the first year he had worked for the city police
department there. As a rookie patrol officer, Eliot put in long hours, night
shifts, and went to school so he could advance in his career. Rhett had been a
rock of support, and Eliot thought he was providing the same love and security
for her.
Yet, there was
never enough money, never enough time for one another. Rhett rarely complained,
but Eliot saw the pained looks when she had to make do with an old dress to wear
to her sister’s wedding. He felt guilty when he could not buy a nice gift or
take her to a special restaurant for their anniversary. He wanted to see Rhett
smile, to hear her laugh, and to be as joyful as she had been in the beginning
of their love. Eliot said he owed her that much and more. He wanted to cherish
Rhett in the same way he saw his parents love one another. Eliot desperately
sought a means to bring their love to life again. The scheme he landed upon
seemed foolproof. It didn’t seem like a crime at all. Take the drugs and
illegal booze confiscated and used as evidence in court cases and sell it back
to the criminals. It was nearly a perfect crime. Nearly.
Eliot’s
thoughts were broken when the hospital room door swung wide and Dr. Oxenbriggs
strode in. Ira sat up straighter. Etta moved toward the tall, bespectacled
doctor and extended her hand.
“Doctor
Oxenbriggs,” she said with a tone of relief. “We’re so glad you’re here.”
“Hey Briggs,”
Ira exclaimed. “Will you tell my warden and jailer here that I’m fine and we
can go to Michigan next week?”
“Hello, Ira,
Etta, Eliot. I must be in the wrong room. I’m supposed to be checking on a
stroke patient,” Dr. Oxenbriggs moved with grace, warmly caressing Etta’s hand
and then in seemingly one motion, grabbing Ira’s outstretched hand.
“I tell you, I
feel great,” Ira said emphatically.
Etta shook her
head and rolled her eyes. “Too great, Dr. Oxenbriggs. He thinks we’re driving
to Detroit just as planned before all this.”
While
listening, Dr. Oxenbriggs examined Ira, checking his eyes with a light, looking
into his ears, thumping on his back, and watching as Ira followed the doctor’s
gestures with his own hands. After a moment, the doctor stood back, folded his
arms, and rubbed his chin.
“Well, Ira, you
did have a mild stroke, and I want to admit you to the hospital for a couple of
days run a few more tests. Then, assuming you keep progressing, you can go
home,” Dr. Oxenbriggs counseled.
Etta offered
her husband and son a satisfied look and walked past Dr. Oxenbriggs to stand
beside Ira, where she began adjusting his blanket and fluffing his pillows
again. Her next words were interrupted by Dr. Ash McKay, who opened the door
and stepped inside. Looking around apologetically, he quickly realized that Dr.
Oxenbriggs was in the middle of a consultation.
“Oh, sorry. Dr.
Oxenbriggs, room 112 needs you—as soon as you can, sir,” Dr. McKay whispered.
Briggs smiled
broadly, reaching out to welcome McKay. “Everyone, please meet Dr. Ash McKay.
He is my chief resident. You will be seeing him from time to time. He’s the
best I’ve seen in years, and we are so fortunate to have him in our community
medical program.”
Everyone in the
room smiled and nodded. Then, turning his attention to Ira, Dr. Oxenbriggs
walked to stand by the bed. He told the West family how he met Dr. McKay
through the Remote Area Medical program and how so many young medical
professionals were learning about the needs in Southwest Virginia through the
RAM. Ash noticed that Dr. Oxenbriggs carefully avoided taking any credit for
attracting the interns or for growing the community medical program that kept
the best and brightest here after their graduation.
People who knew
of Dr. Briggs’ contributions to improving medical care for the people of this
remote region would have said he was being unduly humble. At that very moment,
Ash would have agreed with them. But a few short weeks later, he would find
himself being the only dissenter in a town full of Briggs’ disciples.
“Dr. McKay,”
Briggs proudly stated. ‘I’d like you to meet my favorite patient, Ira West. He
has had a mild stroke. Looks like he’ll recover nicely. But he has some
concerns about going on with his life and taking a planned trip. What would you
tell him?”
This was a
test, and Ash knew it, but he was less certain of the right answer. He knew
from experience that a response that differed from what Dr. Oxenbriggs wanted
could cost him. He felt everyone staring at him. The pressure increased.
“I would tell
you, Mr. West, that Dr. Oxenbriggs is right. Strokes are tricky. Consider this
an ounce of prevention, and take all the time to recover,” Ash hoped the sigh
he released did not betray his anxiety.
After a moment,
Briggs displayed that brilliant, approving smile Ash had come to know so well.
He pulled up Ira’s chart, scribbled a few notes, and placed it back into a
holder on the foot of the bed. Eliot, who had been uncharacteristically silent,
walked toward his father’s bed, where he could look Ash McKay and Oxenbriggs
straight in the eyes.
“If you’re sure
he will improve,” Eliot stated.
“You father has
an excellent prognosis,” Ash McKay said.
“I can hear
you,” Ira West chimed in. “I’m still alive over here.”
“Honey, don’t
be rude. Of course you are!” Etta West chastised her husband.
With a chuckle
and pat on Ira’s arm, Dr. Oxenbriggs swept out of the room. They watched him
disappear into the hallway. Then, Dr. McKay picked up Ira’s medical chart,
studying the notes left by Dr. Oxenbriggs. Quickly glancing back at the door,
McKay flipped through the pages, then furiously wrote down something on the top
page. Although Etta and Ira did not notice, Eliot caught McKay’s struggle to
hide his reaction to whatever he had read in the chart. McKay slid the chart
back into its slot.
“I’ll be on
duty through tonight and tomorrow. So, I’ll check on you later. I’ve added a
couple of tests here, all routine—cannot be too careful. Doc Briggs is right.
Strokes can be tricky,” McKay tried to get out of the room before anyone could
ask any questions, but Eliot confronted him.
“What kind of
tests?”
Ash addressed
his response to Ira, ignoring Eliot. “Just a couple of more in-depth ultrasound
scans—to check the blood flow to your brain, Mr. West. I see they did the CT
and a routine MRI when you came in through the ER. The carotid ultrasound will
show us the carotid artery, which delivers blood to the brain. We just want to
be sure there’s no serious blockage. The second is like the MRI, and again, it
gives us more detail about the blood flow to your brain.”
Etta walked to
face Ash McKay. “Are you sure we need all these tests? You won’t be cutting on
him, will you? Nothing invasive.”
Dr. McKay shook
his head, offering her what he hoped was a comforting smile.
“Mrs. West,
there is no surgery, nothing invasive whatsoever. These tests provide more
detail—help us understand what caused this incident and give us information to
provide more effective treatment for your husband. Are we all in agreement to
move ahead?” Ash waited for their nods of agreement as Eliot stood to leave.
“It seems we
have two good doctors, so I’ll head off. Mamma, want anything from the house? I
know you won’t go home. I can get it and get back before my shift tonight.”
“You won’t need
anything, Mamma,” Ira called out. “I’m going home real soon.”
Dr. McKay
hurried out of the room, hoping to avoid talking with Eliot in the hallway. He
always hated that moment when a doctor was forced to talk to a member of the
patient’s family, especially when that family member was a skeptical police
officer. Besides, Ash was in a hurry to look up some additional information on
the medical protocol for stroke patients. While he knew each doctor had his or
her own methods, something he read in Ira’s treatment plan seemed out of the
standard care. He had to get his information quickly—before Dr. Oxenbriggs
realized he was not on the floor.
