Inadvertent Disclosure (8 page)

“Yes. Thanks.”

“Of course. At a minimum, I’d
perform a MMSE—that’s a mini mental state examination. It takes about ten
minutes. I’d ask the patient a series of questions intended to screen for
cognitive impairment: what time it is; the date; who the president is, that
sort of thing. Also some simple calculations. I’d ask the patient to repeat a
list of words to test for recall. The highest possible score is 30 points. A
score of 25 or higher would indicate no impairment. Between 21 and 24 would
suggest a mild impairment. I’d be most concerned about a score of 10 to 20
points, which correlates to moderate impairment. Anything under 10 indicates
severe impairment and, for a patient at that level, it would be fairly obvious
that there was some age-related dementia or other problem.”

“That’s the standard accepted
test?”

“Yes. There are others, of
course, but most gerontologists will use the MMSE. Sometimes a social worker or
other non-doctor will use an abbreviated MMSE. Some doctors will create their
own unique tests. Pulling from the various accepted tests.” He paused here and
pursed his lips to show his displeasure. “That’s not a best practice and it can
skew results dramatically.”

Sasha wondered if anyone had
performed a diagnostic battery  of any kind on Jed Craybill and wrote herself a
note to find out.

“Since Dr. Spangler isn’t a
geriatric specialist, would it be appropriate for her to administer and score a
test like this?”

Dr. Kayser sighed and pushed
his chair back from his desk. He steepled his fingers together and looked up at
the ceiling tiles before answering. “As I’m sure you can appreciate, that’s a
difficult judgment to make. Is it appropriate for a general practitioner to administer
the test and interpret the results? Certainly, just as it would be appropriate
for a family doctor to perform a pregnancy test or to screen a patient for
hearing loss. In my view, however, the next step, if any of those diagnostic
tools indicated further care was warranted, would be to refer the patient to a
specialist. There are physicians who are board certified in obstetrics,
audiology, and, of course, geriatric medicine for a reason.” He drew his lips
into a firm, thin line when he finished speaking.

“Of course.”

“Now, if I had a patient whose
score on the MMSE concerned me, I would gather additional psychosocial
information, such as the presence of formal and informal support systems,
including membership in a church or club, relationships with neighbors,
relatives, or friends; whether the patient already received any services; and
if any recent psychological stressors were in play.”

“Like the death of a spouse?”

“Absolutely.”

“After gathering all this
information, you would be comfortable making a diagnosis?”

Dr. Kayser straightened his
back. “Some would. And, a diagnosis based on that information would be
defensible. I, however, would not. We’re talking about wresting control of a
person’s life.”

“What other steps would you
take?”

“For one, I would have a social
worker perform a safety assessment of the living environment. Does the
patient’s home have fire alarms, adequate lighting, sturdy stairs, or grab bars
in the bathroom?  Is the home clean and uncluttered?  That sort of
information.”

He stood and paced behind his
desk, his hands clasped together behind his back. “Then, I would consider what
services might be appropriate to provide support to enable the patient to
continue to function independently. Would a walker be helpful?  A medical alert
necklace?  Would an alarmed pill box that dispenses the patient’s medication in
the correct dosage and provides reminders be useful?  Could Meals on Wheels
deliver food to the patient?  Could the patient’s banking be automated, both
for deposits and bill payment?”

He turned and faced her. “There
is a wealth of services and products intended to help people age in place with
dignity. In my view, these should be exhausted first. If, after all that, it is
clear the patient cannot function safely without a guardian, then and only then
would I get on the stand and testify that this patient is incapacitated.”

He sat back down, with a
sheepish smile, like he realized he’d been up on a soapbox.

“This is very helpful
background,” Sasha reassured him, then asked, “How often in your practice do
you ultimately conclude that a patient needs a guardian?  I mean, out of the
times that someone files a petition?”

He rubbed his belly while  he
considered the question. “More than half the time. Sometimes, it’s just clear
as day. The patient is in full-blown dementia, say. Sometimes, we can put off
the determination of incapacitation for months or years by devising an
appropriate care plan, but ultimately, independent daily living becomes too
much for the patient. And, sometimes, a patient like your grandmother will
function independently until she dies in her sleep. Of course, in her case,
your mother was there to help her, if needed.”

He smiled at the memory of her
grandmother, who read
The New York Times
  every day, up to and including
the day she died, and was always ready to talk politics.

Sasha smiled back, then asked
the money question. “Have you ever testified in opposition to an incapacitation
petition?”

He cocked his head and thought.
“No. I don’t believe I have.”

“Will you?”

CHAPTER 10

Tuesday evening

Clear Brook County
Commissioners’ Meeting

Drew Showalter checked the
notes on the podium in front of him. Speaking at these commissioners’ meetings
could be more nerve-wracking than arguing in front of an appellate panel. At
least with judges, he could predict the questions and issues with some
accuracy. But the county commissioners were a retired banker, a minister, and
the owner of a trucking company. He never had any idea what they were going to
ask him.

He snuck a look behind him. The
audience was thin, at least. He saw the politics editor of the paper, the
hapless Danny Trees and a handful of his people, and a cluster of retirees with
nothing better to do on a Tuesday night. Maybe they’d get out of here at a decent
hour for once.

Lately, the monthly meetings
had been running on for hours, what with every red-faced homeowner in the
county wanting to yell about too much fracking, not enough fracking, chemicals
in their water, the noise, the smell, the too-lax regulations, the too-strict
regulations. It was worse than the year they’d done real estate reassessments.

The acid started to rise in his
throat just thinking about it. He popped an antacid and told himself to put it
out of his mind. Being county solicitor was a civic duty. And a guaranteed
forty grand a year.

The commissioners filed in
together, whispering and gossiping. They took their seats behind the long
table.

After the Pledge of Allegiance,
they got down to business. It was clear sailing until they got to the
declaratory judgment actions that Big Sky had filed.

Big Sky. Those guys didn’t mess
around. A day didn’t go by that they weren’t suing somebody over something or
other. And, of course, they used big law firms to do all the work and just
hired someone in town as local counsel to shepherd the cases through the court.
So, it was motion after motion, preliminary objections, and endless discovery
requests. It was like their strategy was to bury the town under paper.

Cort Garland, the retired
banker, started with the questions right away.

“How can they keep filing these
frivolous lawsuits?  Don’t they understand we don’t have the resources to
respond to all these cases?”

The business owner, Heather
Price, snapped at him. “Don’t be naive, Cort. Of course they understand that.
That’s
why
they’re filing all these lawsuits. Right, Drew?”

Heather could be a real ball buster,
but he imagined being a woman in the trucking industry was no picnic.
Especially a woman as drop-dead gorgeous as she was.

He cleared his throat. “I tend
to agree. They’re trying to keep us on the defensive. It’s only going to get
worse, I’m afraid, now that you’ve voted to consider the drilling moratorium.”

Cort jumped in, “I want the
minutes to reflect that I was the lone dissent on that vote.”

Heather rolled her eyes.

Troy Benjamin, the minister,
spoke up in the rich baritone that made him so popular behind the pulpit. “Now,
let’s not revisit settled issues. We agreed that we need to examine whether
we’re being good stewards of the bounty of resources the Lord gave us. Let’s be
at peace with that decision.”

Heather rewarded Troy with one
of her dazzling smiles, and he ducked his head in embarrassment.

Drew had once remarked to his
wife how Heather sure could wrap her fellow commissioners around her fingers
when it suited her. Betty had roared with laughter and said, “Counselor, your
house is made of glass.”

Ever since then, he was
self-conscious around Heather, worried that he came across like a love-struck
schoolboy. It made these meetings even more trying.

Heather turned her violet eyes
his way. “Counselor, what’s the process for these declaratory judgments?  Are
they fast-tracked or what?”

He peeked at his notes even
though he knew the procedure cold. “Well, Judge Paulson has both sides’ briefs.
On the moratorium issue, he also has the amicus brief filed by PORE.”

Behind him, he heard the PORE
members whispering in excitement. It had been a bit of a surprise to everyone
that they’d spent the money to file an
amicus curiae
, or friend of the
court, brief on the issue.

He continued, “Now, Judge
Paulson has set a hearing for early May on the moratorium issue. Because the
council didn’t vote to actually ban drilling but just voted to consider the
issue, he ruled there was no need for expedited review.”

A smattering of boos and hisses
erupted from the PORE contingent.

Cort put a hand up. “Please
control yourselves.”

The noise died down, and Drew
picked up where he’d left off. “On the other issue, Judge Paulson said he
didn’t need to have a hearing. He’s going to decide it on the papers.”

“What’s the timing on that
then?” Heather pressed him.

“Harry Paulson’s a creature of
habit, you know. He hasn’t had a law clerk in years, so he writes all his own
opinions, and he does them in order. First in, first out. Every afternoon,
after a slice of pie, he stands at that window of his and dictates his
opinions. Fridays, he reviews the drafts. That week’s batch goes out the
following Monday, and the whole process starts over. Based on when the briefing
was completed, he won’t get to our case this week, but he’ll decide it one day
next week. So, we should have the opinion two weeks from today.”

Drew looked at the three
commissioners, trying to gauge a reaction. Cort was nodding; he couldn’t tell
whether it was in approval or just understanding. Troy had adopted the peaceful
martyred expression he wore whenever council business held no interest for him.
And Heather was staring right back at him, giving him a heavy-lidded look that
sent a thrill of imagination up his spine.

He reached into his jacket
pocket as inconspicuously as he could and unwrapped another antacid.

CHAPTER 11

Thursday morning

Pittsburgh, PA

“Nice work today,” Daniel said,
pounding Sasha on her shoulder with a fist.

She smiled at her instructor,
lapping up his rare praise. She could tell she’d done well during the
exercises. Her encounter with Jay earlier in the week had reminded her she
couldn’t afford to get lazy.

One of Krav Maga’s tenets was
that repeated, progressive drills under stressful conditions would develop
muscle memory in the student, enabling her to react automatically instead of
freezing. Because human instinct when under attack isn’t fight or flight: it’s
fight or flight or freeze. And while fighting and fleeing were both acceptable
responses, freezing was a good way to get a girl killed.

The way to avoid the freeze
response was consistent, faithful training. But, lately, Sasha had been
slacking off from her early morning training sessions in favor of spending
extra time in bed curled against Connelly’s broad, warm back, listening to his
even breathing, too comfortable to get up.

No more.

She said her goodbyes to the
other students and grabbed her backpack from her locker. Before slipping it on
for the three-mile run home, she took her Blackberry out of the side pocket and
checked for messages. She hadn’t really expected to have a message at seven in
the morning on a Thursday, but she had two. She could tell they’d both been
forwarded from her work line, because no caller identification information was
available.

The first call was from Dr.
Kayser:

Sasha, hi, it’s Al Kayser.
Sorry to call so early, but I wanted to let you know I had a meeting on my
calendar for most of the day that’s been canceled suddenly. I’m going to take
advantage of the block of free time to take a drive and visit with Mr.
Craybill. I should have a written report of my observations to you before the
weekend’s out. Take good care.”

Great news. When Dr. Kayser had
agreed to examine Jed and perhaps testify, his one caveat had been that his
schedule was jam packed. She had been worried she might have to ask Braeburn to
agree to an extension of the briefing schedule. Now, that worry was behind her.

Her next message made clear
that someone else’s worries were eating away at him:

Hi, Sasha. This is Drew
Showalter, calling on the VitaMight matter. I, uh, just wanted to see if you’d
gotten the discovery I overnighted?  I was hoping you’d had a chance to review
it by now. Maybe you could give me a call, so we could talk about any questions
it raised?  Or if you’re planning to be in Springport on your Orphans’ Court
matter, let me know. We could get lunch. Thanks. Bye.

Call him to discuss any
questions his discovery responses had raised?  No one did that. What was going
on with Showalter?

She shrugged. The man was a
mystery to her, but it didn’t matter. She’d resolved not to work on her
Springport cases for the rest of the week. She was going to dig out from under
the work that had piled up while she was out on Monday.

Then, she was going to spend
whatever was left of the weekend with Connelly. Her brothers had invited them
to the hockey game on Saturday night, but Sasha didn’t know how to break it to
them: Not only was Connelly
not
a Pens fan, he was a Rangers fan.

She laughed at the image of the
family drama that confession would create and snapped her backpack straps
across her chest. Then she pushed through the door out to the street and
started her run.

* * * * * * * * * *

Thursday afternoon

Springport, Pennsylvania

Drew was trying to focus on his
objections to the interrogatories the insurance company had served on his
client. His attention kept wandering to the desk phone.

Was she going to call him
back?  It had been several hours since he’d left his message.

You should have waited until
nine o’clock, like a normal person, he chided himself. Who’s in the office at
six forty-five in the morning?  Besides him, of course.

But, Sasha had struck him, for
no good reason, as a morning person. He liked to think he could sense his
fellow early risers. Maybe she did get up early, he theorized, but she had to
get her kids to school or walk her dog.

It doesn’t matter, he told
himself. Who cares if she wakes up at six a.m. or noon?  She just needs to call
me back.

She was going to be his way out
of this . . . morass. Mess didn’t do the situation justice. Predicament sounded
too permanent. No, this was a morass.

He tapped his highlighter on
the desk and tried to ignore the gnawing pain.

It was no use. He pulled open
his top desk drawer and took out the jumbo-sized container of antacids Betty
bought for him in three packs. He jammed a red one into his mouth and waited
for its chalky magic to ease his stomach ulcer.

She’d call. She had to call.