Diagnosis Death by Richard L. Mabry Read Free Book Online Page A

she slept at all? She wasn't sure. Last night's wrong number had been innocent enough, but the dreams that followed it were nonstop torture. Elena wondered if they represented the guilt that filled her subconscious, boiling to the surface like the bubbles in a witches' cauldron. They'd all been there—her late husband, her mother-in-law, her colleagues— all asking the same question. "Why did you do it?"
    She stumbled through some semblance of morning ablutions, threw on the clothing she'd laid out the night before, and headed for the kitchen to make coffee. Thank goodness she'd bought more. It was bad enough to face another day. Doing it without coffee was unthinkable.
    Elena spooned coffee into the pot, daydreaming about her future, when the open can slipped from her grasp and bounced three times on the tile, rolling to a stop against the refrigerator. The entire contents, almost a full can of coffee, formed a dark brown trail across the floor. Elena wanted to scream. She wanted to cry. But instead, she laughed. One more thing had gone wrong, so how many more could there be? Maybe she could use up all her bad luck before she left the house today. Meanwhile, she'd stop at the convenience store on her way to the hospital. Maybe some caffeine would help. Then again, maybe nothing could help.
    Whether it was the tall cup of coffee she drank or the fresh air blowing into her face through the wide-open car window as she drove, by the time Elena wheeled into the doctor's parking lot at St. Paul Hospital, she felt almost human.
    Elena made her way through the hospital, following signs to the Family and Community Medicine Clinic. Funny, the medical center had changed the name to keep up with the times, but everyone still called the department Family Practice. Well, that was what she wanted to do in her own practice—help families. If she just had the chance.
    She took particular comfort that today was Friday. Not because it marked the start of the weekend, though. Illness and accidents don't observe a calendar, and physicians are as likely to be called upon for their services on a Saturday as on a Tuesday. But this weekend was different. Tomorrow she would meet with Dr. Sewell.
    By now Elena wasn't feeling particularly nervous about the meeting. Maybe she'd felt disappointment so many times the possibility of one more held no terror for her. Then again—
    "Dr. Gardner, are you ready to see patients?"
    Elena turned. Mary, the pert, dark-haired clinic nurse, held out a chart.
    "Thanks, Mary. Yes, I'll start."
    For Elena, the patients in the family practice clinic presented the same challenge as a Sudoku puzzle—except the stakes were much higher. She opened the chart and scanned the notes Mary had made. "42 y/o WF. 3 mo. Hx vague aches, lack of energy. BP 110/60, P 68."
    "History of vague aches and lack of energy." Could be something, could be nothing. Elena tapped on the door and entered. "Hi, I'm Dr. Gardner." She extended her hand.
    "Emily Gunderson." The woman's handshake was lukewarm, matching her expression.
    "How can I help you?"
    The woman perched on the edge of the exam table appeared to be closer to 55 than 42. Her eyes were dull. Her voice was husky and soft. She picked at a broken nail as she spoke. "I'm tired all the time. I feel like I've got a lump in my throat. I ache all over. I . . . I feel terrible."
    A century ago, doctors would have attributed these symptoms to emotional problems and called the condition "neurasthenia." Elena gave thanks for the strides medicine had made since then. "When did this start?"
    "Maybe three or four months ago."
    Elena moved behind the woman and placed her fingers lightly on her neck. "Swallow for me, would you?" She increased her pressure slightly. "Again."
    Elena continued to ask questions as she examined the woman's chest, heart, abdomen. Finally, she took a rubber-headed reflex hammer from the table and tapped gently at the bend of the woman's elbows and below her kneecaps.