Silent Fear, a Medical Mystery Read online

  “I’ll fit in it when I’m twenty, egghead. I’m more active than you’ll ever be.”

  “Okay, if it’s settled,” Mary said, “I’ll buy them and you three need to get fitted soon.”

  “By the way,” Sara said, “you haven’t told us. Where are you going on a honeymoon?”

  “We’re talking about going to my previous stomping grounds in Alaska. Casey hasn’t been there. Besides, I still have artwork in a gallery which I need to decide about.”

  Annabel lowered her head. “Melissa would have been in college there by now, Mary.”

  “I know, sweetheart. I know.”

  ----------

  When Danny arrived home he found everyone eating dinner on the patio, including Sara. He opened a back door as Dakota anxiously awaited to greet him. “Hey, Dakota.” Danny rumpled Dakota’s wavy coat as the dog weaved between his legs.

  “We’re about finished but we saved you some,” Casey said, as he stopped scraping the grill clean.

  “Thanks,” Danny said. His heart quickened when he focused on Sara. “Hi Sara, it’s nice to see you.”

  “You too, Danny,” she said. He showered her with a spirited smile and she noted his genuine rapport with Dakota.

  “Hey Dad,” Nancy said. “We’re coming over this weekend.”

  “Good. I hope you don’t mind that Julia will be here, too.”

  “That’s big news, Danny,” Mary said. “Don’t you think we need to get a little prepared? Babies need special things, you know.”

  Danny shot a wistful glance at Sara. “I know, I’ve had experience.”

  “Dad,” Annabel said, “there are a few old things in the basement at the house. You and Mom were a bit like pack rats.”

  Danny looked at Sara. “That’s fine with me,” Sara said. “You girls can bring over any baby items you find.”

  “I’ll help you buy anything else, Danny,” Casey said.

  “Thanks.” Danny took the platter which had the last kabob and pushed the meat, onions, and peppers off the skewer. Mary went in the house for another wine glass, and placed it in front of him.

  “Annabel has good news,” Sara said.

  Rotating her head to show everyone, Annabel raised her upper lip as much as she could.

  Nancy shook her head. “What is that supposed to mean, you idiot?”

  Annabel shot her a fiery glance. “Why don’t you car wash the inside of your mouth!”

  Casey went over to Annabel from behind and gently gave her a head lock. Annabel reached up and pushed his arm away. “When are you getting your braces off?” Casey asked. “You haven’t even had them on that long.”

  “In time for the wedding.” Annabel beamed.

  “The orthodontist said she didn’t have much of a bite issue,” Sara said. “The crooked tooth has straightened and aligned with the others.”

  “Congrats on that,” Danny said. “That’ll shave time off your teeth cleaning.”

  Annabel shook her head. “At least I won’t look like a dork in the wedding pictures.”

  “Who says?” Nancy said.

  “Come on girls,” Mary said, before they lit into each other again. “Let’s clear the table. Your Dad can finish eating.”

  Sara went to get up. “No,” Mary said. “You finish your wine.”

  Mary, Annabel, and Nancy went in the house with dirty dishes. Dakota watched but stayed alongside Danny.

  “I’ll be back,” Casey said, following them, “with another bottle of wine.”

  After putting his fork down, Danny moved his chair closer to the iron table. “I’m glad you stayed for dinner, Sara. We don’t get to talk one on one.”

  Sara felt comfortable after taking a few deep breaths, enough to look at him, especially after the wine had taken the edge off. They didn’t have difficult divorce matters to contend with now, so she needed to relax.

  “But I’m here for other reasons, Danny.” Sara opened her palm, splaying her fingers to suggest a handful of reasons.

  “I know.” Danny allowed a silence, enough to let him concentrate on her orange-ginger aroma from her hair products. “You look so pretty right now. You usually do. I never used to tell you that often enough.”

  “Danny, please don’t.”

  “Okay, but it’s true, and it’s how I feel. I wasn’t too bright but I did make an excellent choice for a wife. And the girls have the best mother.” He smiled but then the smile dissipated from his face as he looked into her eyes. “Sara, I miss you. I really do.”

  Chapter 4

  Except for Matthew Jacob, the newest and youngest surgeon of The Neurosurgical Group of Middle Tennessee, Bruce, Danny, and Harold had full office schedules on Wednesday. It started out partly cloudy as Danny left the big house, but by mid-morning the steady rain outside the office windows amplified the weather channel’s dreary updates.

  Danny finished seeing a regular patient for intracranial hypertension with a VP shunt and slid into the kitchen where Harold contemplated his cup of coffee.

  “What, lousy coffee today?” Danny asked. “Not if Cheryl made it.”

  “Did I hear my name?” Cheryl asked as she walked in and gave Danny the next patient’s chart.

  “I was referring to the fact that you’re the best coffee maker around here,” Danny said. He rolled out a laugh. “Not to mention you’re a crackerjack nurse.”

  “Thanks Dr. Tilson.”

  Danny furrowed his brow wondering about his colleague. Harold sunk his forehead into his hand as he leaned over the counter. Cheryl hesitated from leaving.

  “Dr. Jackowitz,” she said, “are you okay?”

  Harold sat down next to the table, crossed his arms in front of him, and briefly closed his eyes. “I suppose I don’t want any coffee after all.”

  “Harold, you look like you’ve been beaten down by a good party.” Danny said, pulling a chair next to him. “Do you want us to get you anything else?’

  “No, it’ll pass, whatever it is. I feel nauseous and my head is starting to hurt.”

  Bruce walked in with a long stride, his ironed lab coat a bright white, adding to the crispness of his professionalism. “I just put another patient on an upcoming O.R. schedule,” he said, “to have a lumbar laminectomy. Where are all these back patients coming from?”

  “They all get referred to you, Bruce,” Danny said.

  “As it should be.” Bruce looked above his new bifocals, evaluating the situation. “Is there group therapy going on here?”

  “Harold needs some doctoring,” Danny said.

  Harold shook his head and slowly stood up. “I’ll be alright. Must have been something I ate.”

  ----------

  By 3 p.m. the rain had intensified. A few patients called to cancel appointments due to tornado warnings around the area so Danny, Bruce, and Harold tapered their hectic pace. Danny asked Cheryl to bring him the next patient’s chart, went into his office with a soft drink and took a granola bar from his desk.

  Cheryl followed and handed Danny the file. “New patient,” she said, pulling her hair together and sliding it into a pony tail band.

  “Thanks.”

  “This is the lady sent from the ob/gyn doc that gave you a call.”

  Cheryl turned to leave. “By the way, despite Dr. Jackowitz’s best attempts, he’s looking worse by the hour.”

  “Thanks, Cheryl. Why don’t we check on him after this next patient?”

  “I’ll corner him the next time he comes out of a room.”

  Danny read the notes sent from the other doc. He realized it was an interesting case as he polished off the oatmeal bar. Wanda Robinson had a complicated emergency delivery two months ago with copious bleeding and then had difficulty breast feeding. She also reported other symptoms which suggested a lack of hormones or a problem with her pituitary gland, which could have occurred due to blood loss and low oxygen delivery to the gland during that time. The obstetrician re
ferred Mrs. Robinson to an endocrinologist and Danny.

  Danny hurried down the hall to her examination room. He greeted her with a handshake. “It’s not often we see recent obstetric patients,” he commented.

  In her early thirties, Wanda Robinson had small circles under her eyes, a slumped posture, and lackluster eyes. She nodded and said, “First time I’ve ever been to a neurosurgeon’s office, too. I’m taking all sorts of journeys after having my baby.”

  Danny thought of Julia as well as Rachel. Hopefully Rachel was more the picture of health taking care of their child than the poor woman sitting before him. He hadn’t seen his baby for a long time either, a situation he hoped would be remedied next weekend.

  “Have you seen the endocrinologist yet?” Danny asked.

  “Yes, she took all sorts of blood and we’re waiting on the results.”

  “Good. Mrs. Robinson, what your obstetrician, endocrinologist and I are thinking is that you may have an underproduction of hormones since your delivery. The hormones are made in a gland which is small and inside your brain, the pituitary gland. Anyway, it’s called Sheehan’s syndrome and treatment would be to replace these hormones.”

  “The endocrinologist would do that, wouldn’t she?”

  “Yes. However, your other doctors are being careful. That’s where I come in. We should check for other reasons for your symptoms, such as a pituitary tumor. When we assume something in medicine, that’s when we overlook something else that is the cause or another reason for an illness.” Danny smiled. “Does that make sense?”

  “Yes, I see what you’re saying.” She let out a big sigh and uncrossed her legs.

  Danny asked Wanda to sit on the table, examined her, and considered their options. “What I’d like to do is get an MRI to check the size of your pituitary gland.”

  Wanda took the paperwork he handed her. “Thanks, doc. I hope we’re doing it for nothing.”

  “Me too Mrs. Robinson, and enjoy that baby of yours.”

  ----------

  Cheryl signaled for Danny to step into the kitchen where Harold reclined in a chair looking pale. His lab coat hung over his legs and his hand was hidden in his pants pocket, but he wasn’t clanking change like usual.

  In two steps, Danny leaned down near Harold’s expressionless face. “Harold, why haven’t you stopped seeing patients? I hope you don’t feel as bad as you look.”

  “Danny, my head hurts worse.”

  Cheryl inched in closer, too. “Do you mind if I take his temperature?”

  Danny nodded as Cheryl placed the thermometer under Harold’s tongue.

  “We’re canceling the rest of your patients for the day,” Danny said. “Bruce and I shouldn’t see them because we still have a few ourselves and we should let staff go home on time because of the bad weather.”

  No sooner did Cheryl take the thermometer out of Harold’s mouth, when he peeled between Danny and Cheryl and headed for the sink. The light amount of food he’d eaten early in the morning came spewing out of his mouth like liquid chili.

  ----------

  All Danny wanted to do that evening was unwind and relax. He stopped at a local Italian chain restaurant for take-out after leaving the office and called Mary to let her know. At home, he placed the pizza on the counter while Dakota went mad over the aroma steaming from the cardboard box.

  “Dakota,” Danny chided, as he sat on an ottoman. “Are you going to continue begging or give me a proper greeting?” Dakota responded briskly and nuzzled into his hands while Casey’s Jeep pulled into the garage and the house door opened. He came in wearing gym clothes that fit snugly over his chest and part of his arms. He could have impersonated a personal trainer.

  “Good timing,” Danny said. “Now you can eat half that pizza, and undo what you’ve accomplished the last one or two hours.”

  “Hey, watch it. I’ve already accomplished a decent body, it’s the maintenance I’m after.”

  “I’m the one who should be hitting the gym.”

  “You’re not too bad, considering.” Casey tossed his bag on the side of the couch. “Is Mary still working upstairs?”

  “Must be. I phoned her I was coming. She’ll be down in a minute, she must have heard our cars pull in.”

  Danny and Casey both grabbed paper plates, slices of pizza, and iced tea and sat back in the great room as Mary came down.

  “Hi guys,” she said. “I’m finishing up a masterpiece.” She had on denim shorts and a cotton white tee-shirt with advertising, both sprinkled with colorful paint. “Wow, does that smell good.”

  “Did you call the Alaskan Sitka art gallery today?” Casey asked.

  “I did. I told the owner we’d be there in the Fall and I’d make a decision about my remaining paintings. He seemed awfully concerned I was getting married.”

  “I would be, too,” Casey said, “if I weren’t the one marrying you.”

  Mary strode into the room, toeing in her right foot as usual, and grabbed a slice. Dakota sat at her feet staring with full attention.

  “I was swamped with emergencies today,” Casey said. “I think everyone is having their trauma or medical problems now to wrap up the summer months.”

  Danny finished chewing. “We’re overflowing, too, and four of Harold’s appointments didn’t get to see him because we sent him home early. Rare for any of us to get sick, but Harold’s got something.”

  “Poor Harold,” Casey said.

  “He can be a weasel, but we treated him nicely.” Danny tacked on a few chuckles.

  “Oh,” Mary said, “Sara drove the girls over this morning. They put a crib upstairs in the guest room Melissa used to use.”

  Danny’s heart fluttered when Sara’s name was mentioned. “That was nice of them.”

  “It’s not assembled. It was in a box, I guess stored away.”’

  “Want to tackle that project after eating?” Casey asked.

  “For sure,” Danny said.

  ----------

  The next morning, Danny glared down into a patient’s moist gray matter, contemplating the area of meninges to biopsy. He stepped away from the patient’s exposed brain and the cacophony of beeps and valves from the anesthesia machines and studied once again the MRI on the wall’s imaging screen. He stepped back and glanced towards the instrument tray. “Scalpel,” he said.

  Danny made a little incision of irregular-looking brain tissue and dropped it into a small specimen cup that the scrub tech held over the tray. “For pathology,” he said. The circulator took care of sending the specimen off while Danny further examined the area.

  “You’re awfully quiet up there,” Danny said.

  Dean, the anesthesiologist, peeked around to see Danny more clearly. “I’ve been chasing the patient’s high blood pressure since we started.”

  “I was wondering about that. Lucy Talbot was in here the other day and she can be chatty, but she had her hands full, too.”

  “Our group cherishes her. She’s a good doc and gets along with everybody. I haven’t seen her today, though. I think she may be out sick.”

  Just then the intercom sounded and the circulator put the pathologist on the loudspeaker. “Danny, it’s Devin. You sent down a fine specimen. It’s a non-cancerous meningioma, just like we suspected when we talked.”

  “Clear cut pathology then?”

  “For sure, Danny, it’s a pathologist’s dream.”

  “Okay, thanks. See you at the next medical staff meeting.”

  Danny and Dean both exchanged looks of relief as Danny’s pager beeped. “It’s the office,” the circulator said as she dialed the number. She talked to Bruce and then hung up. “Dr. Garner said that Harold is in the E.R. He’d like you to see what’s going on when you can.”

  “Did he mean as a patient?” Danny asked.

  “I believe so.”

  Everyone’s tasks seemed to hurry quicker than normal as it was obvious Danny needed to go check on h
is colleague. When he finished aligning the skull piece and suturing the scalp, Danny stepped back and removed his gloves as the OR head nurse overseeing the schedule walked in.

  The nurse nodded at Danny and then addressed her staff in the room. “Can you two stay over after your shift today? We’re backed up and I’m already missing Dotty and James.”

  She barely waited for their reluctant okays when she spun around again and left mumbling, “Dotty and James better be sick.”

  Dean unlocked the foot pedal and swung the table forty-five degrees back to him. “We’re okay here,” he said to Danny. “I’ll have him extubated and in recovery room soon.”

  “Thanks Dean. Thanks everybody.”

  As Danny walked through the lounge, he slid on his white coat. He had some time between cases to visit the ER and didn’t have to hustle. In any case, he bounded down the steps to the first floor. With regular shift hours, Casey had the luxury of going to the gym. Since Danny wasn’t so lucky, he made sure he frequented the hospital staircases instead of the elevator.

  On the ER schedule board, Harold was listed in room 5. Danny turned the corner to a semi-closed door where he saw the ER doc inside talking to Harold, who lay supine on a stretcher. Danny decided to give them some privacy as Casey and his partner, Mark, pulled a stretcher through the hallway and stopped at room 6.

  A flurry of personnel surrounded the stretcher as they pushed it in the room. Casey gave them a report and the man they brought in succumbed to hands and monitors being placed all over his chest. The man’s right calf had shattered flesh and dripping blood and the crumpled sheets were crimson. An ER doc curved around Danny, went in, and took charge. The fast talking doc spoke with Casey as she stopped to eye the EKG.

  “He had chest pain at the same time?” she asked Casey.

  “Precisely,” Casey said. “He shot himself in his leg while cleaning his gun, which I think precipitated angina.”

  “This is a heart attack in progress, I believe.” She stood alongside the stretcher and shook her head.

  The man grinned. “Guess I won’t be cleaning my gun again anytime soon,” he said slowly.

  “It doesn’t look like you’re too proficient in that skill,” she said.