Chapter Text
Seven Years Ago
Emory University Hospital
Atlanta, Georgia
“So Leo, what bet did you lose to pull the overnight shift on a Saturday night?” the charge nurse asked the physician leaning casually against the wall.
“Why ever would you assume that?” Leonard McCoy answered, his tone of voice feigning innocence.
“Senior research fellows who double as surgeons don’t pull emergency room duty. Especially on holiday weekends,” one of the interns clustered around the nursing station said.
“I’m a simple country doctor …” McCoy began.
The chief resident standing nearby rolled her eyes.
“… who relishes any opportunity for treating patients,” McCoy finished.
“Uh-huh,” the charge nurse responded with a skeptical expression and sounding less than convinced. “Rumor is you caught our illustrious medical director in a mistake.”
“That you pointed it out during grand rounds. In front of the new crop of surgical interns,” the chief resident added.
“And will be on the weekend emergency room rotation for the next three months,” another intern finished.
McCoy swiveled facing the intern and grumbled, “We point out your errors. In front of your peers. Why should that be any different for the brass?”
“But we aren’t Dr. Mark’s peers!” the intern exclaimed.
“Of course you are,” McCoy responded emphatically. “Everyone in this room is a health care professional and therefore a peer of mister ‘too big for his britches.’” Now wound up, McCoy settled into a frequently voiced tirade. “In fact, you children need to see that no one, no matter how experienced and talented, no matter what position to which they are rightly or wrongly promoted, is immune from making an erroneous diagnosis. Our patients deserve rigorous attention to detail and others’ input.
“So you admit to it?” the veteran nurse said with a grin.
McCoy’s expression turned sheepish before morphing into triumph. “Damn right. And if he whose name must be whispered in reverent tones can’t take the heat, he needs, as my Grandmaw says, to get out of the kitchen.”
A first-year resident exited a nearby exam room looking for the charge nurse. “Anna, I’ve got a child presenting with a simple ear infection. I prescribed the standard treatment. But the mother is nearly hysterical. Says her daughter has been sick for months. I’d appreciate your help.”
McCoy waved Anna back into her seat. “Take a break, I’ll do it.”
The resident looked nervously at Anna; she returned the unspoken question with a smile and a faint nod. He then handed a digital tablet to McCoy who refused it with a headshake, instructing. “Give me the highlights.”
“Yes, sir. The child is female, 30 months old. Presents with an ear infection including pain, tinnitus, dizziness, and infrequent vertigo. I administered an injected antibiotic and prescribed an oral follow-up for the next seven days. Her mother documents multiple ordinary childhood illnesses over the past nine months.”
“Hmmm, anything else of interest?”
“Those are all the symptoms … the child does not take any maintenance medications and is not currently undergoing any other forms of treatment,” Evan replied.
McCoy raised an eyebrow. “Anything else?”
“Ah … nothing of note … they recently returned to Earth after spending a couple of years with the construction crews building the colony structures on Uranus.”
“Did you run any additional tests?” McCoy continued his inquiries.
“No, sir. Not with the obvious symptomology.”
“Knock it off with the sirs, I’m a …” McCoy held up his hands encouraging a response from the others.
“Doctor, not an insecure bigshot requiring sycophants,” the interns repeated in unison.
“There may be hope for you children after all,” McCoy replied with a chuckle. He grabbed a modern version of the ancient stethoscope. In answer to the sideways glances among the junior physicians he said, “Scanners can’t replace a healer’s five senses. If I teach you nothing else, remember that. Okay, somebody find out what atmosphere processors are in use on Uranus.”
“Why?” asked one of the nursing students.
“YNK,” McCoy replied.
“You never know,” Anna whispered to her pupil. “It’s a Leo McCoy motto.”
McCoy inclined his head. “Any teddy bears left in the bin?”
Anna retrieved the requested stuffed animal and tossed it to doctor. “Nice catch,” she observed, “for a man of your years.”
“I try to keep in practice despite being over thirty,” McCoy responded in a dry tone. He then pinned Evan with a sharp gaze. “And the most important information?”
Baffled, the young doctor shook his head slightly and raised his shoulders.
“Their names,” McCoy prompted with impatience.
“Oh. Joanna is the patient. Mrs. Alderson is her mother.”
McCoy gestured to the exam room’s door. “Let’s get to it then.”
Jocelyn looked up as the duo entered, her eyes immediately drawn to the handsome face and deep blue eyes of the older physician. He probably has a nice smile … though a smile would be inappropriate, she thought, this is a serious place. But his calm confident expression is soothing in all the right ways… “What? I’m sorry, would you repeat …”
“I’m Dr. McCoy ma’am,”
His southern drawl eased her tension further.
“But most folks call me Leo.” He did smile when looking down at the child sitting on the biobed. “You must be Joanna.”
The little girl nodded and sniffled. “Ear hurts.”
“I know sweetheart. It’s gonna feel better real soon,” McCoy assured her. He retrieved the teddy bear from his pocket. “This is my friend Earl. If it’s okay with your Mama, maybe you will hold him for me while I listen to your chest?”
Joanna glanced at her mother who mouthed, “Sure.” She eagerly held out her hands and then hugged the bear tightly.
“Okay darling this is going to feel a little cold. Deep breath for me?” McCoy demonstrated. The child inhaled. “Okay, breathe out.” He demonstrated. Joanna mimicked. “Again. And again. Now your back.” While he repeated the process, McCoy said quietly to Evan, “Add a 2.5mg nebulizer to her prescriptions.” With Joanna happily chatting to the bear, McCoy stepped closer to her mother and spoke in a conversational tone. “Mrs. Alderson, you mentioned your daughter has suffered from an unusual number of mild illnesses over the past several months?”
“Oh, I’m not Mrs. Alderson anymore … I mean we’re divorced …” she stammered. Why did I bring that up? “That’s why she and I moved back … just call me Jocelyn. Yes. Joanna no sooner gets over a cold then a week later she’s picked up a respiratory infection or a virus. The physician on Uranus said frequent minor bugs are not unusual for small children in the insular environment of a domed construction zone and that Joanna would grow out of it.” Her eyes watered. “I’m new here … on my own … don’t know anyone … with her never-ending illnesses … it’s exhausting.”
“I understand,” McCoy said, his voice soft. Leaning closer he gave the distraught mother his full attention. “Have you noticed anything else?”
“This is going to sound silly.”
“I doubt that. You’re her mother, no one knows Joanna better than you. Go on.”
Jocelyn took a deep breath and summoned her resolve. “The doctor on Uranus … she said it wasn’t anything to worry about … that I should be grateful … I’ve never had any trouble getting Joanna to nap. Or to go to bed at night.”
“Because she is tired?” McCoy prompted.
“Yes, I think so. And she doesn’t play much with others. Not because she is shy, it just seems like … it’s too much for her.”
“That’s good information,” McCoy encouraged.
The door swished open. An intern entered. “Here’s the data you requested.”
“Excuse me ma’am,” McCoy said. Meeting the intern at the door he scanned the offered digital tablet and frowned. Looking up he asked Joyelyn, “Does Joanna bruise easily?”
“Ah … I never thought about that … but yes, especially in the past four months. One time she scraped her knee and it bled for thirty minutes before stopping. There wasn’t a lot of blood, but it seemed like an eternity. And then her knee swelled up like a balloon afterwards. Is it related?”
“Hmmm. Possibly. Nothing to be alarmed about. I’d like to run a few more tests if you permit me. As a precaution,” McCoy assured. After Joycelyn’s weak nod, he beckoned Evan over and ordered, “Run a complete blood scan. Stat. I want counts for white blood cells, red blood cells, and platelets. And ask Anna to come in and sit with Joanna.”
Returning to Jocelyn McCoy said, “May we talk privately? My colleague will stay with your daughter.”
Fear gripped her like a vice. Nodding weakly, she followed the physician into an office and sat in the offered chair. Her hands fidgeted. She wiped her eyes.
He handed her a glass of water before sitting in a chair behind the desk and opposite the distraught mother.
Funny how having something for your hands to do calms, Jocelyn thought. “Doctor?”
“Leo,” he reminded.
“Leo, is it serious?”
“Let’s not jump the fence before we see what’s in the pasture.”
“Wwhat?”
“Let’s see the results before rushing to worse case scenarios. How long did you and Joanna live on Uranus?”
“We moved there when Joanna was six months old. It was awful. Always dark and cold, the ice storms and their winds a constant background whine like white noise. I couldn’t take it anymore. I begged Luke to leave his job and move back. He said we needed the money, and it would only be for two more years … Sorry.” She placed the glass of water on the desk. “You’re the first person in a long time who has listened to me and believed what I said.”
McCoy rested his elbows on the desk and steepled his fingers. “Then please continue.”
Jocelyn looked down and to the side. “It’s nice, having someone listen. Everybody needs that in their lives. Luke and I, well, we quit hearing one another sometime last year. We started talking at one another instead. Please don’t think badly of him, I was as much at fault. His work is brutal. We were saving every penny to buy a little place in the sun … again sorry.”
“Not at all. The pressures of work and family are hard enough without living in a hostile environment.” The test results flashed on the terminal in front of McCoy. He reviewed them with a neutral expression. Moving to the front of the desk, he stood in front of Jocelyn and said in a gentle voice, “Your daughter is ill.”
Jocelyn burst into tears and jumped to her feet throwing her arms around McCoy.
He held open his arms and whispered, “May I?”
She nodded.
Embracing her, McCoy traced circles on Jocelyn’s back. She lost herself in the feeling of strength and comfort found in his arms. When the flow of her tears slowed, he withdrew and offered his handkerchief.
She wiped her eyes with the offering.
“Ready?” he asked.
She nodded weakly.
“Joanna is ill and there is a treatment. I’m going to refer you to a friend; she’s a specialist in this area. After I get your daughter admitted and you get her settled, we’ll discuss the diagnosis and next steps. Then I’ll arrange a comm link with Joanna’s father. There will be a bed for you in her room. You need sleep and care too.”
ooooo
Present
Emory University Hospital
Atlanta, Georgia
Nine-year old Joanna skipped into the waiting area, her parents following closely behind. Seeing a familiar face she ran to Evan who leaned down and administered a bear hug.
“Here for your check-up?” he asked.
“Yep.”
“I have a new intern today; can he join us too?”
“Sure.”
“We will see you in a few minutes.”
Turning to his student Evan asked, “Did you study the chart for this case?”
“Yes sir.”
“I prefer a more informal stance, as my mentor did. You can drop the honorifics.”
The intern recited, “Aplastic anemia due to bone marrow and DNA damage from trace amounts of radiation emitted when the noble gas triargon is part of the artificial atmospheric mixture in subzero environments. Inert gases break down in those conditions rather than remaining stable. The resulting illness is very rare as a recessive gene must also be present in homo sapiens for the radiation to be detrimental. DNA resequencing and stem cell treatments eradicated the condition with no lasting or permanent effects. I memorized the file. It was a brilliant diagnosis.”
“Which I missed,” Evan replied. “I saw the immediate problem, an ear infection. Leo McCoy teased out the disparate threads from random bits of information and connected them. That was the day I truly started learning how to be a good physician. If I teach you nothing else, let it be the importance of seeing the big picture rather than the most immediate image in front of you. Get started on vitals, I’ll join you in a moment.”
Evan dreaded these annual visits. After Jocelyn’s choice, a choice breaking McCoy’s heart into a million pieces, he wanted to refer this case to another physician. Instead, as a favor to his friend and mentor, Evan pushed through his bitterness and managed a cordial relationship with Jocelyn for Leo and Joanna’s sake. He was less sanguine of maintaining such a rapport with her once his own daughter was born in three months. Once he experienced firsthand what McCoy lost.
Sighing, Evan joined the family in the exam room.