Crisis (2 page)

Over the previous year, Craig had become committed to -- even obsessed with -- transforming himself into a more interesting, hap-pier, well-rounded, better person and, because of it, a better doctor. On the desk of his in-town apartment was a pile of catalogues from various local universities, including Harvard. He intended to take classes in humanities: maybe one or two a semester to make up for lost time. And best of all, thanks to his makeover, he'd been able to return to his beloved research, which had completely fallen by the wayside once he'd started practice. What had started out in medical school as a remunerative job doing scut work for a professor studying sodium channels in muscle and nerve cells had turned into a passion when he was elevated to the level of a fellow researcher. Craig had even co-authored several scientific papers to great acclaim while he'd been a medical student and then resident. Now he was back at the bench, able to spend two afternoons a week in the lab, and he loved it. Leona called him a Renaissance man, and although he knew the description was premature, he thought that with a couple of years of effort, he might come close.

The origin of Craig's metamorphosis had been rather sudden and had taken him by complete surprise. Just over a year previously, and quite serendipitously, his professional life and practice had changed dramatically with the double benefit of significantly raising his income as well as his job satisfaction. All at once it had become possible for him truly to practice the kind of medicine he'd learned in medical school, where patients' needs eclipsed the arcane rules of their insurance coverage. Suddenly, Craig could spend an hour with someone if the patient's situation required it. Appropriately, it had become his decision. In one fell swoop, he'd been freed of the dual scourge of falling reimbursements and rising costs that had forced him to squeeze more and more patients into his busy day. To get paid, he no longer had to fight with insurance personnel who were often medically ignorant. He'd even started making house calls when it was in the patient's best interest, an action that had been unthinkable in his former life.

The change had been a dream come true. When the offer had unexpectedly come over the transom, he'd told his would-be benefactor and now partner that he'd have to think about it. How could he have been so stupid not to agree on the spot? What if he had missed the opportunity to grab the brass ring? Everything was better, save for the family problem, but the root of that issue was how submerged he'd been from day one in his former professional situation. Ultimately, it had been his fault, which he freely admitted. He had let the exigencies of current medical practice dictate and limit his life. But now he certainly wasn't drowning, so maybe the family difficulties could be resolved in the future, given enough time. Maybe Alexis could be convinced how much better all their lives could be. Meanwhile, he resolved to enjoy bettering himself. For the first time in his life, Craig had free time and money in the bank.

With an end of the bow tie in each hand, Craig was about to try tying it again when his cell phone rang. His face fell. He glanced at his watch. It was ten after seven. The symphony was to start at eight thirty. His eyes switched to the caller ID. The name was Stanhope.

"Damn!" Craig blurted with emphasis. He flipped open his phone, put it to his ear, and said hello.

"Doctor Bowman!" a refined voice said. "I'm calling about Patience. She's worse. In fact, this time I think she's really sick."

"What seems to be the problem, Jordan?" Craig asked as he turned to glance back into the bathroom. Leona had heard the phone and was looking at him. He mouthed the name
Stanhope,
and Leona nodded. She knew what that meant, and Craig could tell from her expression that she had the same fear he had -- namely, that their evening was now in jeopardy. If they arrived at the symphony too late, they'd have to wait for the intermission to sit down, which meant forgoing the fun and excitement of the entrance, which both had been keenly anticipating.

"I don't know," Jordan said. "She appears unnaturally weak. She doesn't even seem to be able to sit up."

"Besides weakness, what are her symptoms?"

"I think we should call an ambulance and go to the hospital. She's greatly perturbed, and she's got me concerned."

"Jordan, if you are concerned, then I am, too," Craig said soothingly. "What are her symptoms? I mean, I was just there at your home this morning dealing with her usual medley of complaints. Is it something different or what?" Patience Stanhope was one of less than a half-dozen patients that Craig labeled "problem patients," but she was the worst of the group. Every doctor had had them, in every kind of practice, and found them tedious at best and maddening at worst. They were the patients who persisted day in and day out with a litany of complaints that were, for the most part, completely psychosomatic or totally phantom and that could rarely be helped by any therapy, including alternative medicine. Craig had tried everything with such patients, to no avail. They were generally depressed, demanding, frustrating, and time-consuming, and now with the Internet, quite creative with their professed symptoms and desire for lengthy conversations and hand-holding. In his previous practice, after ascertaining their hypochondriasis beyond a reasonable doubt, Craig would arrange to see them as infrequently as possible, mostly by shunting them off to the nurse practitioner or to the nurse or, rarely, to a subspecialist if he could get them to go, particularly to see a psychiatrist. But in Craig's current practice setup, he was limited in his ability to resort to such ruses, meaning the "problem patients" were the only bugbears of his new practice. Representing only three percent of his patient base, as reported by the accountant, they consumed more than fifteen percent of his time. Patience was the prime example. He had been seeing her at least once a week over the last eight months and, more often than not, in the evening or at night.

As Craig frequently quipped to his staff, she was trying his patience. The comment never failed to get a laugh.

"This is far different," Jordan said. "It's entirely dissimilar to her complaints last evening and morning."

"How so?" Craig asked. "Can you give me some specifics?" He wanted to be as certain as possible about what was going on with Patience, forcing himself to remember that hypochondriacs occasionally actually got sick. The problem with dealing with such patients was that they lowered one's index of suspicion. It was like the allegory of the shepherd boy crying wolf.

"The pain is in a different location."

"Okay, that's a start," Craig said. He shrugged for Leona's benefit and motioned for her to hurry. If the current problem was what he thought, he wanted to take Leona along on the house call. "How is the pain different?"

"The pain this morning was in her rectum and the lower part of her belly."

"I remember!" Craig said. How could he forget? Bloating, gas, and problems with elimination described in disgustingly exquisite detail were the usual complaints. "Where is it now?"

"She says it's in her chest. She's never complained of pain in her chest before."

"That's not quite true, Jordan. Last month there were several episodes of chest pain. That's why I gave her a stress test."

"You're right! I forgot about that. I can't keep up with all her symptoms."

You and me both,
Craig wanted to say, but he held his tongue.

"I think she should go to the hospital," Jordan repeated. "I believe she's having some difficulty breathing and even talking. Earlier, she managed to tell me she had a headache and was sick to her stomach."

"Nausea is one of her common afflictions," Craig interjected. "So is the headache."

"But this time she threw up a little. She also said she felt like she was floating in the air and kind of numb."

"Those are new ones!"

"I'm telling you, this is altogether different."

"Is the pain visceral and crushing, or is it sharp and intermittent like a cramp? "I can't say."

"Could you ask her? It may be important."

"Okay, hold the line!"

Craig could hear Jordan drop the receiver. Leona came out of the bathroom. She was ready. To Craig, she looked like she belonged on the cover of a magazine. He indicated as much by giving her a thumbs-up. She smiled and mouthed: "What's happening?"

Craig shrugged, keeping the cell phone pressed to his ear but twisting it away from his mouth. "Looks like I'm going to have to make a house call."

Leona nodded, then questioned: "Are you having trouble with your tie?"

Craig reluctantly nodded.

"Let's see what I can do," Leona suggested.

Craig raised his chin to give her more room to work as Jordan came back on the line. "She says the pain is terrible. She says it's all of those words you used."

Craig nodded. That sounded like the Patience he was all too familiar with. No help there. "Does the pain radiate anywhere, like to her arm or neck or any other place?"

"Oh my word! I don't know. Should I ask her?"

"Please," Craig replied.

After a few deft maneuvers, Leona pulled on the looped ends of the bow tie and tightened the knot she had made. After a minor adjustment, she stepped back. "Not bad, even if I say so myself," she declared.

Craig looked at himself in the mirror and had to agree. She had made it look easy.

Jordan's voice came over the phone. "She says it's just in her chest. Are you thinking she's experiencing a heart attack, doctor?"

"It has to be ruled out, Jordan," Craig said. "Remember, I told you she had some mild changes on her stress test, which is why I advised more investigation of her cardiac status, even though she was not inclined."

"I do remember now that you mention it. But whatever the current affliction, I believe it's progressing. I believe she even appears rather blue."

"Okay, Jordan, I'll be right there. But one other quick question: Did she take any of those antidepressant pills I left this morning?"

"Is that important?"

"It could be. Although it doesn't sound like she is having a drug reaction, we have to keep it in mind. It was a new medication for her. That's why I told her not to start until tonight when she went to bed, just in case they made her dizzy or anything."

"I have no idea if she did or not. She has a lot of medication she got from Dr. Cohen."

Craig nodded. He knew very well that Patience's medicine cabinet looked like a miniature pharmacy. Dr. Ethan Cohen was a much more liberal prescriber of medication than Craig, and he had originally been Patience's physician. It had been Dr. Cohen who had offered Craig the opportunity to join his practice, but he was currently Craig's partner more in theory than in fact. The man was having his own health issues and was on an extended leave that might end up being permanent. Craig had inherited his entire current roster of problem patients from his absent partner. To Craig's delight, none of his problem patients from his previous practice had decided to pay the required fee to switch to the new practice.

"Listen, Jordan," Craig said. "I'm on my way, but make an effort to find the small vial of sample pills I gave Patience this morning so we can count them."

"I will give it my best effort," Jordan said.

Craig flipped his phone shut. He looked at Leona. "I've definitely got to make a house call. Do you mind coming with me? If it turns out to be a false alarm, we can go directly to the concert and still make the entree. Their house is not that far from Symphony Hall."

"Fine by me," Leona said cheerfully.

While pulling on his tuxedo jacket, Craig went quickly to his front closet. From the top shelf, he got his black bag and snapped it open. It had been a gift from his mother when he'd graduated from medical school. At the time it had meant a mountain to Craig because he had an idea of how long his mom had to have squirreled money away without his father knowing to afford it. It was a sizable, old-fashioned doctor's bag made of black leather with brass hardware. In his former practice, Craig had never used it since he didn't make house calls. But over the last year he'd used it a lot.

Craig tossed a bunch of supplies he thought he might need into the bag, including a bedside assay kit for myocardial infarction or heart attack biomarkers. Science had advanced since he'd been a resident. Back then it could take days to get the results back from the lab. Now he could do it at the bedside. The assay wasn't quantitative, but that didn't matter. It was proof of the diagnosis that was important. Also from the top shelf he pulled down his portable ECG machine, which he handed to Leona.

When Craig had formally separated from Alexis, he had found an apartment on Beacon Hill in the center of Boston. It was a fourth-floor walk-up duplex on Revere Street with good sunlight, a deck, and a view over the Charles River to Cambridge. The Hill was central to the city and fulfilled Craig's needs superbly, especially since he could walk to several good restaurants and the theater district. The only minor inconvenience was the parking problem. He had to rent a space in a garage on Charles Street, a five-minute walk away.

"What are the chances we can get away in time for the concert?" Leona asked when they were on their way in Craig's new Porsche, speeding westward on Storrow Drive.

Craig had to raise his voice against the whine of the engine. "Jordan seems to think this might be legit. That's what scares me. Living with Patience, he knows her better than anybody."