DELAYED DIAGNOSIS - CHAPTER ONE

I always wanted to be a hero. Another part of me, almost as strong, almost as needy, wanted to be kept safe and protected by a hero of my own. The two sides of me were in constant contradiction, an internal discord I thought I had resolved by attending medical school. I had thought being a doctor would provide a way out of my miserable, ugly-duckling youth. I thought that I could save the world and make a good living, finding friends, a husband and children along the way. That I would blossom in the rarefied atmosphere, a Florence-Nightingale-like MD in mink and diamonds, copies of "How to Win Friends and Influence People" and "Dr. Spock" under my arms. That was youth dreaming, egotistical and idealistic. Some parts of it worked out well enough though I wear scrubs instead of mink and diamonds, and having the MD hasn’t meant kids and love ever after.

My first year as a med. student squashed my ideas of my own superiority, and residency took care of the rest. I lost John - my fiancée - most of my compassion, and am still in hock up to my armpits for medical school. But I have friends. It was a talent I always had, the making of friends. Real friends, not the casual, speak-to-you-if-I-get-time, forget-you-if-you-move-away or get-transferred-to-another-department, kind of friends, but lasting friends. The life-long kind..

And because of my best friend, because of Marisa, I accomplished the first dream of my youth, only to discover that being a hero wasn’t all it was cracked up to be. It could in fact, make my second dream impossible to attain.

I had never been a coward, but it took all the courage I ever had to walk in to Marisa’s room. She was just sitting there, slightly slumped, her face and form in silhouette, framed by the window and rising sun. Unmoving. A mannequin in shadow.

I reached for all the instincts created by four years of medical school and three years of residency. All the cool dispassionate calm and impersonal stoicism pounded into me by impossible hours of study and other people’s heartache and pain. That professional calm had deserted me. Everything I learned, everything I thought I knew vanished like low-lying fog in the face of dawn.

Marisa didn’t rise to greet me. Didn’t lift her head. Didn’t move at all except for the slow rise and fall of her shoulders. The usual scent of Chanel Number Nine she had worn for years had been replaced with the faint scent of sickness - feces and the ammoniac smell of urine in diapers. I clutched the door frame, a weakness in my knees that had nothing to do with the lack of sleep or the long night in the ER.

She didn’t move. I crossed the room to the rocker where she sat beside the bed, bundled into an afghan in the too-warm room. Knelt before her, eye to eye. She blinked. Tears gathered at the corners of my eyes, making her waver with motion not her own.

Her face was bruised, the left orbit purplish and green, the lid puffy with fluid. Her hair, only two weeks past so gloriously thick and blond and always perfectly secured with pins in some elegant version of a French twist, was lank, hanging parted in the middle. Her breath stank from teeth left un-brushed.

It was true. All that the ER crew had said when I walked in from my two weeks in the Appalachians, still covered with the sweat of our last, cold hike up some well traveled tourist path, still carrying the anger of John’s last words, our last good-bye. It was all true. Marisa had had a cerebral vascular accident. A stroke, just thirteen days past. And her prognosis didn’t look good.

Steven, Marisa’s husband and my immediate supervisor in the Emergency Room, had taken her home from the hospital, making it clear that Marisa was to receive no visitors. She needed rest interspersed with bouts of intensive therapy, not socializing. But even after all I had heard last night, all the horror stories of the morning Marisa had been found and brought in by ambulance, I hadn’t expected this... this....

I tried to position my eyes so hers would fall on mine, so she would recognize me, come back to me, show me that she was going to recover. Marisa only blinked. When I did the same, my tears fell, and God knows I hadn’t cried in years.

Angrily, I knocked back the tears with my wrist. Doctors learned early not to put fingertips to eyes. Contagion. Viruses left beneath the nails. My hands shook. My breath was too fast, coming up from my lungs in quick little gasps that sounded somehow like sobs. I lifted my hand to touch her, shake her, slap her awake from her stupor as in some old movie.

My hand arrested in midair. Fingers curled. And focused on the drop leaking beneath Marisa’s nose. Odd little drop of....

Slowly I reached forward, touched the single drop of bloody fluid below Marisa’s left nostril. It was cold. Startled, I jerked back my hand and started to rise.

I stopped, the motion arrested, the drop of fluid caught on my finger, trembling in the sunlight that struggled up over the horizon and in through the window. I took a deep breath. It too trembled as I stared at the fluid. Slowly, the drop rolled down my finger tip, into the shadow of my hand.

Standing, my knees groaning like a grandmother’s, I carried the fluid to the window and the pallid Friday morning sun. Outside the house, scudding clouds took on a golden hue. A bird sang off somewhere, a warbling throaty tune. Leaning into the dawn, my back to Marisa, I touched thumb to the drop, dabbing it gently, swirling the fluid.

I turned my back to the morning and looked at Marisa, struggling against the tears that clogged my throat and thinking processes. Drawing upon the medical detachment that allowed a doctor to see a patient as no more than a series of symptoms pointing to a diagnosis, I looked at her again, breathed deeply, and forced calm into my system as I observed her. Studied her not as a friend, but as a patient

Marisa was pale and non-responsive, staring sleep-walker-style at the corner of the room. There was nothing to stare at. The corner was empty.

I re-crossed the room and knelt again at her side, touched her skin. It was cool and dry. As I measured her respiration I took her pulse through the thin fabric of her nightgown. Twelve and shallow. Eighty and steady.

The January sunlight was strengthening by the moment, brightening the cheery yellow room, highlighting the bruises that marred her flesh. In medical school, while my complexion grew sallow and dull from the long hours and stress, Marisa’s had remained vibrant, lovely. The traditional peaches and cream of a plantation owner’s daughter. No longer.

Bruises stained the skin beneath and above the left eye, a hematoma circling the orbit. A small circular wound was healing just beneath the brow bone where the flesh was puffy and swollen, edematous. When she blinked, that lid moved a fraction of a second after the right one and opened sluggishly.

There was a healing scar above her left eye, the pale white and pink puckered irregularities of recently removed stitches in sharp contrast to her skin.

Even with the presence of the strange fluid, nothing I was seeing was, by itself, abnormal for a stroke patient who might have fallen and hit her head. But taken together....

The small wound above Marisa’s left eye was oddly circular - too regular, too symmetrical - one centimeter in diameter, as though she had landed on an up-turned unsharpened pencil and the rough end had penetrated the skin creating an abrasion. She had a subconjunctival hemorrhage in the inner corner of the eye, the white of the eye stained a bright crimson. And the pupil was blown, dilated to its full width. Marisa was blind in that eye.

I lifted her wrists which resisted slightly, the pressure equal in both sides. When I dropped them, they fell slowly, settling into Marisa’s lap. Marisa had some motor function left....

I whirled, my heart slamming painfully in my ribs. It was Essie. Only Essie. My coconspirator and Marisa’s long-ago Nanny, standing in the doorway wearing a day-dress and slippers.

"She always so smart and all and beautiful as that Princess Diana was. And now she sit and stare. Just don’t seem right."

"No reason, Dr. Missy Rhea. Dr. Steven done all he could to bring her back. I seed it with my own eyes." Essie shook her head slowly and shuffled into the room. Nearly eighty, Essie did everything slowly. But she had been with Marisa’s family for over seventy years, and was as much family as Marisa’s blood. She had kin in Charleston, a daughter here in town and other family up north somewhere, but neither Marisa nor Essie would have thought of parting.

"That man done holler and weep and all going on. Fell out hisself when he brung her home. I seed him, fell out in the floor. I bring a dab of ammonia like Missy Marisa done showed me how to do. Wake him up after a while it did. And him cry like a baby." Essie shook her head. Which matched my judgment about the situation perfectly. I didn’t believe it either. Steven Braswell never displayed emotion in public and seldom in private. And certainly not in front of the servants. He was an iceberg.

Essie eyed me, her mouth in a tight line, arms crossed over her chest as she considered. "You got to be gone before that nurse come. Dr. Steven say no visitor, not even family, exceptin’ the nurse, and the muscle man."

"Well you hurry then, Dr. Missy Rhea. I too old to be standing in line for unemployment. And too old to be hunting me a job."

"You get fired and I’ll hire you myself. It’ll be the best move I ever made."

"I love you Essie." I kissed her on the cheek, turned and ran for the back door and the brand new BMW Z3 I had left in my drive, a quick run through the woods.

Three minutes later I was back, breathing deeply from the exercise. Essie was sitting in her favorite overstuffed chair by the gas logs in the Keeping Room, knitting piled on her lap. Pointedly she looked up at the clock as I passed.

Flipping on all the lights in the bright yellow room, I dispelled the last of the gloom left by the night and checked my watch. If I pushed it I could do a thorough exam in ten minutes. A quick one in five flat.

The room was silent around me as I worked, black bag to my side, instruments clicking, whooshing and pumping, tapping rubber on flesh. Normal. Everything was normal. Slipping the stethoscope from around my neck, I inserted the ear pieces and unrolled the blood pressure cuff, rolled up the sleeve of Marisa’s nightgown. And stopped.

The bruise was fading, bluish green around her wrist bones, pale pink over the artery which pumped steadily beneath the surface. It was about five inches long and circled Marisa’s wrist. And it had the unmistakable shape of a large hand.

Gwen Hunter’s books have been sold in the USA, Italy, France, Germany, Holland, Australia, New Zealand, the Philippines, and the UK, where her best seller STOLEN CHILDREN (the UK title for the novel BETRAYAL) won the W.H. Smith award for best first novel. Gwen's latest book, GRAVE CONCERNS, is a lead title from MIRA BOOKS. Look for it in book stores January, 2004.