Silent Fear, a Medical Mystery (20 page)

Danny had two immediate concerns that needed to be dealt with. He wished he could snap his fingers to make them resolve, like from a genie’s blink of an eye.

People were dying from meningoencephalitis. Talking again to Joelle and Ralph, perhaps seeing one or both of them, was imperative. And with Julia, his brain practically froze just thinking about her. If she was being abused, it would be sinful to give her back to her mother. He only had her for two days and yet the legal turnings of a Family Court didn’t spin on a Saturday or Sunday. And in essence, he needed stat verification of the injuries she was wearing.

For the first time in months after meeting Rachel and Julia once in Knoxville, he was getting to see his baby girl, and now it would be one big scramble to sort out this new development. Rachel sure knew how to dump on him. He felt pressure inside his head like one of his own patients with high intracranial pressure.

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Danny remembered his Sheehan’s patient Wanda Robinson. She had her infant with her the last visit, commented about her well-baby check, and had good things to say about the pediatrician in Danny’s building. On rare occasions in recent years, Danny had dealings with pediatricians for his youngest patients, and he would occasionally see Dr. Thomas come and go from the building. The man had prematurely lost most of his hair and covered up with a ridiculously obvious toupee. He wondered if kids stared at his rug while he examined them.

Danny had to procure an emergency pediatrician appointment. Most pediatricians didn’t work on Saturday, but Danny called and found out Dr. Thomas would close at noon, and they would work Julia in. He then called Joelle and asked her to come to his office where he planned on waiting for Julia’s appointment. The pediatrician’s office staff promised to beep Danny after he filled out their paperwork and Julia’s appointment was imminent.

After Danny padded back into the house with Julia and Dakota and made his phone calls, the kitchen stirred with morning activity. Everyone was present except Casey.

“Who wants to come with me?” Danny asked. “I’m going to my office to wait for the infectious disease doc and bring Julia to the pediatrician in the building.”

Mary’s dark blue eyes honed in on him. “Casey’s working three to eleven so he’s still sleeping and I shouldn’t wake him. I’m coming, but I’m staying in these baggy gardening shorts and tee-shirt.”

Nancy stirred butter into two boiled eggs but shot a glance at her sister.

“I wish it was a work day at your office, Dad,” Annabel said, “so I could tail you all. But count me in.”

“It’s not like I don’t have anything to do getting ready for school,” Nancy mumbled.

“Don’t do us any favors,” Annabel said.

“No, I’m doing you a favor,” Nancy said. “I’m coming.”

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Danny’s restless legs wouldn’t let him sit down in his own office. Mary and Annabel sat on
the leather couch on either side of Julia, who mimicked her father, her little legs and arms busy with movement. Danny stepped around Nancy, who sat on the floor, and went into the office kitchen to put on a pot of coffee. He came back with two half-filled Styrofoam cups sitting atop a donut box and put them down on his desk.

“Look what I found in the fridge,” he said. “A half box of donuts from yesterday.”

“Awesome,” Annabel said. She left the couch for thirty seconds, selected chocolate, and bit in as she sat down. It didn’t take long to put a little piece in Julia’s hand after pinching it off without the chocolate.

Danny’s pager vibrated, the message coming from the pediatrician’s office. “Annabel and Nancy, you stay here, especially if it takes us awhile. Plus, Dr. Lewis may show up. Enjoy the donuts. We’ll be back as soon as possible.”

He settled Julia in his arms, and Mary and Danny walked out. Nancy grabbed a custard donut when he left and the girls talked about school.

The long, narrow waiting room upstairs was dotted with parents, infants and children. Danny nodded to the receptionist that they arrived. The baby boy in its father’s lap across from them wore yellow-green nasal discharge. An energetic baby playing with toys was there for shots or a well-baby check. A small child walked past them with a productive cough and took a book from the rack. He wished Julia was there for a common cold instead of the horrors present under her clothes.

The white door next to the receptionist’s area opened. “Dr. Tilson, you can bring Julia back,” said a young woman wearing puppies on her scrubs. Danny followed her with Julia clinging to his tee-shirt and Mary filed behind him, her right foot toeing in as usual.

After the nurse added information on a form and left, Danny and Mary sat silently in stiff chairs. They heard someone outside take the chart from the plastic bin, the door opened, and the fifty year-old pediatrician strolled in. Shaking Danny’s hand, and with a husky, gruff voice, he greeted Danny and was introduced to Mary.

“Saul, thanks for fitting us in. This is my daughter, Julia, who lives in Knoxville with her mother. It’s a long story.”

“I believe I’ve heard the crux of your story, Danny,” he said. “You know how the rumor mill is. Even in the OR, I bet personal news travels like wild fire.”

“Hopefully, you’ve at least heard truthful renditions,” Danny said. “Anyway, this is the first time, this weekend, that I have been able to have my daughter. There are marks on her that are disturbing. I would appreciate your examining her and giving me your opinion.”

Saul leaned against the examining table listening intently, his arms crossed in front of him. .

“So you’d like me to give her a full examination?”

Danny nodded.

Saul proceeded to sit down across from them and take a history. In the end, he reiterated to Danny. “As far as you know, then, the mother had no troubles during the pregnancy? Julia was born full term and never was on a ventilator? There are no medical problems so far and she hasn’t had any surgeries or allergies to medicines? You also believe that the Mother has kept up with all her routine immunizations.”

Danny gestured affirmatively to all his questions. “I believe that sums up what I know. Also, Julia’s mother used to work in an OR as a scrub tech, so I don’t think she’d neglect her routine care.”

Saul’s eyes darted to Danny and he grimaced. “If we’re suspecting child abuse, then there’s no guaranteeing that she regularly took Julia to a pediatrician.” Saul motioned for Danny to put her on the examining table.

When Danny sat back down, he buried his face in his hands. Mary patted his shoulder. The same young nurse as before stepped in to assist in case her boss needed anything.

The pediatrician started with an otoscope and checked inside Julia’s ears. After he finished examining her head area, Mary signaled for Danny to keep sitting, stood up and took off Julia’s colorful bodysuit and diaper. Saul unwrapped his stethoscope from around his neck and listened to the infant’s heart and lungs and palpated her abdomen.

“She sounds fine,” Saul said, replacing his stethoscope.

Danny looked over as Saul started a peripheral evaluation of Julia’s skin and extremities. The doctor’s toupee was easy to spot. It helped divert Danny’s attention from his daughter’s petrified glare at the doctor. The five minute examination seemed to drag on for hours.

“I’d like to get some x-rays,” Saul said, spinning around. “Let’s wait until I get those, and then I’ll go through my findings with you.”

“Okay,” Danny said. He felt like a helpless parent.

Saul’s nurse slipped Julia’s diaper back on quickly and the three of them left together, the pediatrician to see another patient, and the nurse to help in their x-ray room.

“He’s being thorough, Danny,” Mary said. “Let’s keep our fingers crossed, okay?”

Gulping down the desire to get emotional, Danny wrung his hands. “I know why he’s x-raying her. It’s worse than I thought. He suspects broken bones.”

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Mary held Julia when the nurse brought her back. Walking back and forth by the window, Mary rubbed Julia’s back but watched her brother. She worried as much about Danny as Julia. “Fretting isn’t going to help right now,” she said to him.

“I feel like acid is eating away at my stomach. Damn! I just realized I wasn’t supposed to be on call last weekend. I covered what was supposed to be Harold’s call because Bruce and Matthew couldn’t. My damn career got in the way. I would have had Julia, found out about her condition, and maybe prevented something that happened to her last weekend.” He jumped out of the chair, ready to pound his fist into the wall.

Mary confronted him face on, holding Julia tight. “Don’t you dare throw a guilt trip on yourself. You have a responsibility with what you do. Shit happens. You can’t change certain paths, Danny. You should know that more than anybody.”

The pounding pulse in his wrist began to subside as he searched Mary’s dark blue eyes. She stared back at him, ready to take him on if he gave her or himself more grief. He slinked back into the chair. “I suppose you’re right.”

Mary grinned and resumed rubbing Julia’s back as they heard footsteps outside the door. Dr. Thomas entered with one step to the examining table where he placed x-rays and opened Julia’s folder to his notes. “Why don’t you both sit down?” he said.

Saul’s tense facial expression warned Danny. He felt throbbing around his temples and tried to keep his hands from fidgeting. Meanwhile, Mary obliged the doctor’s request.

“First off,” Saul said, “your suspicions were correct. There is crystal clear abuse going on with your daughter. But here’s some good news first. Your daughter seems to be okay from a heart and lung perspective. And this is also good - I don’t see it often if child abuse is suspected, but her weight and length is normal on growth charts. There is no failure to thrive. It makes me think that the primary caretaker is not responsible for the injuries we’re seeing.”

Danny and Mary shot each other a glance. It seemed strange … he couldn’t figure that out, yet he didn’t have a clue about Julia’s life with her mother.

“Otherwise,” Saul said, “I don’t know where to start. The mark on her upper inside right arm that’s circular with the ragged edges is a cigarette burn. As a partial thickness burn, she will probably keep that small scar. The other one on her buttocks is undoubtedly a full thickness cigarette burn and that’s a nasty disfiguring scar which is going to stay.” He paused. “Thank God it’s not on her face, Danny.”

Danny shuddered. He looked at Julia, all innocence in Mary’s arms.

“Mary,” Saul said, “basically the differences with skin damage from burns depend on the depth of injury to the skin layers of the epidermis, dermis, and subcutaneous tissues. A superficial burn to the outermost layer of the epidermis has the best healing. In this case, we’re not so lucky.”

“This is so evil,” Mary said. “I can’t take it when I hear about animal abuse, but I’ve had no exposure to this.”

“Well, I’ve got more to tell you. As Danny knows, at the bottom of your sternum is an end plate called the xiphoid process. Julia’s has been fractured.” He took the two x-rays from the table and slid them into the viewing box behind them as they both stood and got out of the way. He pointed to the bottom of Julia’s breast plate, or sternum.

“No, no, no,” Danny whispered.

“How did that happen?” Mary asked. “Was she punched or something?” Mary cringed saying it.

“Not necessarily. It can be done with finger or thumb pressure. An outright punch would more likely also cause internal organ damage.”

He pointed to the adjoining film. “This is Julia’s left arm. She has a spiral fracture of her humerus. In an infant, it’s indicative of someone jerking the baby’s limb. As Danny knows, shaking a baby can result in severe head trauma, but I don’t see evidence of that.”

Saul hated giving such information to any parent. Pediatrics wasn’t always a joyous specialty. “Julia’s arm also has a bruise” he added, “like a handprint.”

After giving Danny and Mary a few seconds to absorb his findings, he forged ahead. “Luckily, Julia’s arm fracture is healing. The bone is coming together nicely and there is nothing further to do for either break. I hope you can take her out of harm’s way.”

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Their heads hung low, Danny and Mary brought Julia back to Danny’s office where Joelle sat with Annabel and Nancy in the waiting room. “Well, I see you’ve all met,” Danny said. “And Joelle, this is my sister, Mary, and my other daughter, Julia.”

“Nice to meet you, Mary, and I’ve enjoyed talking with your daughters, Danny. Annabel’s been picking my brain about my specialty. I told her if she’s going to go the med school route, neurosurgery and infectious diseases are equally rewarding.”

Danny laughed, which felt like a release from the morning’s tension. “I won’t arm wrestle you over that one.”

“Are you a runner?” Danny asked. She was dressed in running shoes and airy black shorts and a purple top and smiled wholeheartedly at Julia.

“I try,” she said. She swiped a wrist band across her upper lip.

“My colleague Matthew Jacob is an avid runner, too.” Danny said. “Why don’t we all go back to my office? Annabel, would you mind giving Julia some milk and the baby food jar we brought?”

“I’ll do it,” she said with a small smile to hide her braces. She took Julia from Mary and brought her to the kitchen while Nancy followed.

“Joelle, I hope you don’t mind if I make an emergency phone call,” Danny said. “I have somewhat of a crisis going on with my baby.”

“Not at all, is there anything I can do?”

“You already have your hands full with our epidemic.”

“I’ll have to fill you in, Danny, however, I don’t bear good news today either.”

Danny looked through his cell phone contacts for Mark Cunningham’s number. He scowled at himself. It was a number he should know by now. He didn’t expect to find his attorney in the office on a Saturday, so he tried his cell phone number. The way he saw it, Julia was supposed to go back to her mother the very next day but now that seemed out of the question. That would be like putting a fawn in front of a cougar.

On the other hand, Danny had continued to learn from Family Court. He knew an order was an order and his documents spelled out visitation rules. He’d be breaking the judge’s order if he didn’t bring her back to her mother. This had to be worked out legally, and yet how could that happen in one day? His thoughts spun as he placed the call, only to get a recorder.