Royal Pains : Sick Rich (9781101559536) (2 page)

“Ouch,” I said.

“Some of them could use a swift kick.”

Better them than me.

Chapter 2

The next morning Divya and I headed out to see patients—three follow-up visits and one new patient. Evan went along to drive the new HankMed van. We had had it a few months now and both Divya and I had to admit that it was cool. And it did help with making house calls.

We could carry more medications and equipment with us. The portable X-ray and ultrasound machines alone saved time, money, and trips to the hospital radiology department. We could now perform these tests at the patient's home. Convenient. The staple of any concierge practice. Our patients loved convenient.

While Evan drove, Divya rode shotgun. I sat in the back with my laptop hooked up to the plasma screen that folded down from the ceiling. It wasn't the forty-two-inch one that Evan had originally wanted but rather a more manageable thirty-two inches.

“Check this out,” Evan said. “I can put the GPS map up on the screen back there.”

Immediately the image of my laptop screen disappeared, replaced by the navigation window..

“Pretty cool,” I said. “Now can I have my laptop back?”

“Don't you want to see where we're going?”

“I can look out the window for that. Right now I have to get these files up to date.”

Evan tapped the dashboard touchscreen and the image on the plasma screen reverted to my laptop.

“I hesitate to say this,” Divya said, “but I'm really impressed with the van. I had my doubts, but I must admit it has definitely made our job easier.”

“Evan R. Lawson at your service. That's my job. To make your life easier.”

“And when you're not as annoying as a green fly, you do fairly well in that regard.”

Evan picked up his cell phone from where it lay in a central console tray and extended it toward Divya. “Would you say that again?”

“Not likely. In fact if I get a chance to erase all the other stuff you've recorded, I will.”

“Too late. I've uploaded it to my cloud.”

“The cloud that floats around in your brain?”

“Funny,” Evan said.

It was. I laughed. Evan glared at me in the rearview mirror.

“Don't encourage her,” he said.

“I need no encouragement,” Divya said.

Evan R. Lawson is right.

“Put that down.”

He did.

“Regardless,” Evan said, “I'm glad you're mature enough to say I'm right when I'm right.”

“Whether the van was useful or not was never a question,” I said. “The problem was being able to afford it. And to your credit, you did work that out.”

Evan's cell phone rang. He glanced at the screen as he picked it up.

“Speaking of paying for it.” He punched the speakerphone button. “Hi, Rachel.”

“Sorry to bother you but I wondered if either Hank or Divya could come by and take a look at one of my workers.”

Rachel Fleming and her father owned Fleming's Custom Shop, the birthplace of the HankMed van. Evan's stroke of genius was to negotiate a deal where we got the use of the van for two years and then owned it in exchange for providing health care to their employees. We performed their employment physicals and took care of injuries and illnesses that occurred at the shop.

“What happened?” I asked.

“Oh, hi, Hank,” Rachel said. “One of the guys grabbed a hot muffler. Burned his hand pretty badly. I told him to put some ice on it. I hope that was the right thing to do?”

“That's exactly the right thing to do. We're on our way.”

Evan ended the call.

“I guess you can program your GPS to actually take us somewhere,” I said. “Like Fleming's Custom Shop in Westhampton.”

“But I know where that is,” Evan said.

“I just hoped fiddling with it would keep you occupied while I finish my notes.”

Evan punched in the address and a blue line appeared on the dashboard map display. “Got it,” he said.

“That was quick,” I said.

“Evan R. Lawson is a master programmer.”

I shook my head. “Okay, master programmer, follow the little blue line and let Divya and me get some work done.”

“Divya's not working.”

Divya pulled her schedule book from her purse. “Now I am.”

It took only fifteen minutes to reach Fleming's. Evan swung into the lot and parked between two freshly waxed vans, one black with huge windows on each side, the other a bright metallic blue with a California surf scene on the side.

Rachel came out the front door and walked toward us. She gave Evan a hug.

My brother the charmer.

“These new?” I asked, indicating the vans.

“Hot off the press. Customers are coming to pick them up around noon.”

“I like the blue one,” Evan said.

“A guy is buying it for his son. He's nineteen and moving to LA for school. Big into surfing, so this is what we came up with for him. The kid has no idea. I'm sure he'll freak.”

“Who wouldn't?” Evan said.

Well, I wouldn't for one, I thought. But then I'm not a West Coast surfer dude.

“Come on,” Rachel said.

We followed her inside. She led us down a hallway to the break room, where we found Ralph Beacon sitting at a wooden table with his forearm resting palm up on the surface. He cupped a baggie filled with ice in his hand.

I sat down across from him. “How did this happen?”

“A guy we did a job for a couple of weeks ago came in saying his muffler was making some odd noises. He was in a hurry, so I got right on it. But”—he shrugged— “I got a little ahead of myself and didn't think that the muffler might be hot.”

I lifted the ice bag. Several large blisters surrounded by erythematous tissue covered his palm. So did a greasy coating.

“What's this?”

“Butter. My mother always said to put butter on a burn.”

“That's not exactly the best thing,” I said. “It tends to hold the heat in and make the injury worse. The ice is good, but the butter not so much.”

Divya opened the medical bag and pulled out a pack of sterilized instruments and gauze. She handed me a bottle of Betadine solution. I soaked a square of gauze with it and grasped his wrist firmly.

“This is going to be a little uncomfortable, but I have to clean it and get all this butter off.”

“Go ahead. Couldn't be any worse than grabbing that muffler.”

I gently washed his hand, removing the butter and cleaning the damaged skin as best I could. Then we walked to the sink, where Divya rinsed his hand with a bottle of sterilized water. I patted it dry with a wad of sterile gauze and we returned to the table.

I pulled on a pair of surgical gloves while Divya opened up the instrument kit. I removed the sterile tweezers and scissors inside.

“The burn has probably damaged the skin nerves in the area, so this shouldn't hurt much. If any. I just need to empty out these blisters.”

It took only a couple of minutes to open them and drain the yellowish fluid that had collected inside. I then smeared the area with Silvadene cream, layered on a nonadherent Telfa pad, and stuffed the palm of his hand with a wad of sterile gauze. Finally, I wrapped his entire hand with gauze strips and taped it. It looked as if he was wearing a white cotton boxing glove.

“Not exactly a Band-Aid, is it?” Ralph said.

“It might look like overkill, but this is how an injured hand needs to be dressed. It's called the position of function. Sort of a half fist. Makes the healing go better, with less chance of complications.” I smiled. “Of course, you're going to have to keep this clean and dry. I'll give you a prescription for some pain medications and antibiotics. I'll also arrange for you to see a hand surgeon tomorrow.”

“Is that necessary?”

“You don't want to mess with this. If it heals well you'll never have trouble with it. But if it gets infected, it can blossom into a really nasty third-degree injury and that changes the whole ball game. Surgery, skin grafting, loss of use of your hand, things like that.”

He smiled. “You don't sugarcoat it, do you, Doc?”

“Sometimes. But not with something like this.”

He glanced up at Rachel and then back to me. “What about work? I'll still be able to work, won't I?”

“Only if you can do something that doesn't require your hand. And something that will keep it clean and dry.”

“I think a few days off might be best,” Rachel said.

Ralph shrugged. “I have some vacation days built up. I can use them.”

“You also have sick days,” Rachel said. “Let's use those so you'll get paid.”

“How can I turn that down?” Ralph stood. He looked at his bandaged hand and then at me. “Thanks, Doc.”

Ralph left the break room.

“How's the health fair going?” Rachel asked.

“Great,” Evan said. “We have all the sponsors lined up and all but two of the booths sold. Tell your dad thanks for ponying up for one of them.”

“You guys are going to have a booth there?” I asked.

“We'll be there promoting our sports nut line.”

“Sports nut line?”

Rachel laughed. “It was actually my idea but Dad jumped on it as soon as I told him. It's really called our Sports Enthusiast Edition. We configure vans and SUVs for various sports. We have one for skiers, one for surfers, scuba divers, and even soccer moms.”

“What exactly do you do?” I asked.

“You saw the surfer one outside. And we just finished one for a scuba diving group. We created a custom top rack to hold an inflatable boat and racks in the back compartment for storing the tanks and other equipment. We even mounted an air compressor for refilling the tanks.”

“Clever.”

“Thank you. We can change out the roof racks so that the buyer can carry everything from canoes to skis. And we can configure the rear storage area to accommodate almost anything. Dozens of baseball bats and balls, surfboards, cross-country skis, you name it.”

“Sounds like it's been successful.”

Rachel nodded. “Amazingly so. We've been doing it for a year and at last count we'd sold twenty-three units.”

“Maybe you'll sell some more at the health fair,” Evan said.

“That's the hope.”

Rachel led us back into the parking lot, where Divya and I climbed into the HankMed van. Evan stood at the open driver's-side door.

“We still on for lunch later this week?” Rachel asked.

“Absolutely. Any day better than another for you?”

“My dance card is fairly open.”

Evan climbed into the van.

“Call me later and we'll decide,” Rachel said.

“Cool.”

Rachel pushed the door shut, turned, and headed back inside.

“Hmmm,” I said as Evan pulled out of the lot and merged with traffic.

“What?” he asked.

“Nothing.”

“We're just friends.”

“That's what I thought.”

“No, really.”

Chapter 3

“He's in his room,” Rosemary Moxley said. “Where he always is.”

Rosemary had been a HankMed patient for at least a year. She had called, saying that her son, Kevin, was acting odd. Odd how? Moody, isolated, angry. Sounded like a typical teenager to me, but the worry in her voice was real. Rosemary was not the worrying type, so if she had concerns about her son so did I.

After leaving Fleming's Custom Shop, we had swung by Shadow Pond and dropped Evan off so he could head to his sponsor appointments. We then picked up coffee at Jill's favorite spot and detoured by the high school to take it to her. “Grateful” doesn't do her reaction justice. Rosemary's call came while we were talking with Jill.

We now sat at a rectangular wooden table in Rosemary's breakfast nook, a spacious and open area adjacent to the kitchen. Through the windows I saw a tree-shaded pool, a half dozen leaves floating on its surface. Slanted rays of morning sunlight dappled the surrounding deck.

“What exactly has been going on?” I asked.

She dabbed her tear-reddened eyes with a napkin that she then wadded in her hand. “It all started last year. I know you remember when my husband died.”

I did. Rosemary took it hard. Depression mixed with anxiety and the sleep deprivation that invariably accompanies that combination. It had been rocky, but she'd weathered it with the help of the right medication and a good psychiatrist.

“Of course.”

“Kev never really recovered from losing him. I almost didn't either.” She offered a weak smile and then sniffed back tears. “His schoolwork suffered. He quit baseball and basketball. Started using marijuana.”

She took a deep breath and stared beyond me toward the wall for a minute. I waited, giving her time to get the story out at her own pace.

“He became withdrawn,” Rosemary continued. “Moody and sullen. Didn't often go out with his friends. Still doesn't. And that used to be a constant problem. Really the only thing we argued over. He wanted to be with his friends all the time, but we wouldn't allow him to be out every night like he wanted. Now he stays locked up in his room. He rarely eats and has lost . . . I don't know . . . I'd guess twenty pounds. He certainly didn't need to.” She fell silent and stared at her hands, now folded on the table before her.

“What happened today that prompted you to call us?” Divya asked.

“He's different.”

“How?” I asked.

“He's hyped up. Jittery. He seems confused and doesn't make much sense when he talks.”

“Confused?” Divya asked. “In what way?”

“I made breakfast this morning. He didn't really eat any. Maybe a few bites. The whole time he talked about all sorts of stuff. Jumping from one topic to another. Like a runaway train. Kept tapping on the table and bouncing his leg.” She looked at me. “It's drugs, isn't it?”

I nodded. “Could be. How old is Kevin now?”

“Sixteen.”

“Can I go talk with him?”

“Please.” She stood.

“I mean alone.”

She hesitated.

“It might be best. He's more likely to tell me the truth.”

She collapsed into her chair again. “I suppose that's true. Lord knows he won't talk to me.” She nodded toward a hall across the dining room from where we sat. “His room is the last door on the right.”

I grabbed my medical bag and walked that way. The hallway was lined with family photos. Some were of Rosemary and her late husband. Others were older. Black and white and grainy. Probably the grandparents. But most were of Kevin. As a baby, in a crib, butt bare, head up with a wide toothless grin. As a very young boy in a cowboy outfit, cap pistol aimed at the photographer, black hat pulled low over his eyes, a snarl on his face. Trying to look like an outlaw, no doubt. Others were school and sports photos, several of baseball and basketball teams.

I rapped on the door. “Kevin?” No response. I rapped harder. “Kevin?” I called, a little louder this time. Still no answer. I pushed the door open.

Kevin sat at a desk, his back to me, earbuds jammed in his ears, a music video on his laptop, head bobbing, hands playing air drums.

“Kevin?”

Still no response.

I walked over and tapped his shoulder. He jumped and whirled around, tugging the buds from his ears.

“Who are you?”

His face was sweat-slicked, pupils dilated. His gaze bounced around the room.

“You don't remember me?” I asked.

He stared blankly.

“I'm Dr. Lawson. Your mother's doctor.”

“Oh. Yeah?” His knee bounced to an internal rhythm now.

“She wanted me to talk with you.”

“About what?”

“May I?” I motioned toward the bed next to his desk.

“Sure.”

I sat.

He wiped his palms on his jeans and eyed me suspiciously.

“How are you doing?” I asked.

“Fine. What's this about? I mean, I have things to do so I don't have much time.”

“What things?”

That seemed to confuse him.

“You know. Things.” He looked around the room. “Lots of things.”

“Kevin,” I said. His gaze snapped back to me. “What did you take?”

“Nothing, dude. Why would you ask that?” Another swipe of his palms on his jeans, this time leaving behind moist streaks.

“Is it okay if I examine you?”

“What do you mean?”

“Just listen to your heart and lungs. That sort of thing.”

“Why?”

“To humor your mom. She's worried. If I find you're okay I can reassure her.”

The little white lies we tell to get patients to do the right thing. The truth was that I was as worried as she was. Maybe more so, if that was possible. Just looking at Kevin told me he was on speed. Or meth or some other upper. Didn't take a genius to see that.

“Only take a minute,” I continued.

“Okay, I guess.”

I checked his blood pressure. Elevated at one-eighty over one hundred. Heart rate one-ten. I then lifted his shirt and placed my stethoscope on his chest. I could feel his heart through my fingers as much as I could hear it. Hard and rapid. Almost leaping against his chest. I moved to his back. “A couple of deep breaths.” He did. Clear. I folded my stethoscope and dropped it into my bag.

“I'm okay. Right?”

I smiled. “I need to check a couple more things. Hold your hands out flat. Palms down.”

“Why?”

“Kevin, this'll only take a minute. Let's just get it over with. Okay?”

He extended his hands toward me. His fingers trembled. I then used my rubber reflex hammer to test his elbow and knee reflexes. Both exaggerated. I then aimed a penlight at his eyes. His pupils were widely dilated and only partially reacted to the light.

“I'd like to draw some blood.”

“No.”

“Why not?”

“What for?”

I took a deep breath and let it out slowly. “Look, Kevin. I know you're using something.” He started to say something, but I stopped him with a raised hand. “It's got you all hyped up. Whatever it is, it's dangerous. Potentially deadly.”

“No, it's not.”

“What is it?”

“Nothing.”

“Kevin?”

“It's nothing.”

“Show me.”

He hesitated, then stood and walked to his dresser. He removed a baggie from deep toward the back of the bottom drawer and handed it to me. Inside were three small pink pills.

“What are these?”

“They're called Strawberry Quick. They're feel-good pills. They make you feel happy.”

“You don't look happy to me. You look frazzled. Worn-out.”

He sat down again, his leg resuming its dance. “I'm fine.”

“Really?” I saw a camera on his desk. “Let me see that.”

He handed the digital camera to me. I examined it, quickly locating the
ON/OFF
button and the shutter release.

“Look at me,” I said. He did and I snapped his picture, the flash causing him to recoil slightly. I handed him the camera. “Upload this to your computer.”

He did and then opened the picture. I walked over and grabbed the photo of him that sat on his dresser. Looked like it had been taken maybe a year ago. He was smiling, a baseball cap slightly tilted on his head. I returned to where he sat and held it next to the laptop screen.

“What do you see?”

“Me.”

“And?”

He studied them for a minute.

“See how handsome you were? When was this picture taken?”

“Last year.”

“See the difference?”

It was stark. A year ago Kevin looked healthy, with full cheeks and bright eyes. Now his cheeks were sunken, dark bags hung beneath his eyes, and his dilated pupils gave him a cornered-animal look.

“Let me show you something else.”

I opened up his Web browser and typed
methamphetamine
into the search window. A list of links popped up. I selected the one titled “Meth User Photos.” An array of thumbnails appeared. I enlarged one of a young man about Kevin's age and moved it until that photo and the one I had just taken were side by side.

“See this?” I indicated the framed photo. “This is where you were a year ago.” I then pointed to the computer screen and the picture I had just taken of him. “This is where you are now. And this—” I now pointed out the meth user's photo. “This is where you're headed.”

He stared at the user's photo. The young man had deeply sunken cheeks, recessed, dark eyes, and sores and scabs over his face. His teeth were yellowed and deformed.

Kevin's eyes widened further.

“This stuff will kill you.” I held up the baggie. “It's methamphetamine.”

His knee bounced higher, faster, but his gaze dropped and held the floor.

“You know what that is?”

He shrugged. “They told me it was harmless.”

“It's packaged to look that way. Why do you think it's pretty and pink and called by such a harmless name? How could something called Strawberry Quick be harmful? It sounds so fresh and clean. Like a new Kool-Aid flavor.” I wiggled the bag. “It's all marketing, Kevin. Just to get you hooked. Then they'll own you.”

He gave me a brief glance and then dropped his gaze back toward the floor.

“Let me ask you this.” His gaze rose again. “Is this how you saw your life back then?” I pointed to his year-old picture. “When you were playing sports and had friends? When you actually laughed?”

Tears collected in his eyes. “No.” He sniffed and swiped the back of one hand over his nose.

“Don't you think it's time to turn back the clock?”

“Maybe.” The knee started again. “I don't know.”

“Who sold this to you?”

“I don't want to get anybody in trouble.”

“Whoever sells this stuff is not your friend.”

“I know.”

“Then who did you get these from?” I held up the bag.

“I don't know.”

I sighed and then stood.

“What are you going to do?”

“Talk with your mom.”

He reached for the baggie, but I moved it out of reach.

“Those are mine,” he said.

“Not anymore.” I walked to the door and turned back. “Sorry, but I can't stand by and let you kill yourself.” I waved the bag. “And these will do exactly that.” I nodded toward his computer. “Study those pictures. Really look at them. That could be you.”