Fatal Cure

12

To David's and Angela's disappointment, it was still raining in the morning. In contrast to the gloomy weather, however, Nikki was in high spirits and doing marvelously. Even her color had returned. The sore throat, presaging an extended illness, had disappeared with the antibiotics, indicating that if it had been infectious, it had been bacterial rather than viral in origin. Thankfully there was still no fever.

"I want to go home," Nikki repeated.

"We haven't talked with Dr. Pilsner," David reminded her. "But we will, sometime this morning. Be patient."

After the visit with Nikki, Angela left for the lab while David went to the nurses' station to pick up Marjorie's chart. He'd been considering discharging her until he walked into her room. Her response to his greeting told him something was wrong.

"Marjorie, what's the matter?" David asked as he felt his own pulse quicken. She was lethargic. He touched the back of his hand to her forehead and her arms. Her skin was warm to the touch. He guessed she had a fever.

Marjorie responded to David's persistent questioning with barely intelligible mumbling. She acted drugged although not in any apparent pain.

Noticing Marjorie's breathing was mildly labored, David listened carefully to her chest. He heard faint sounds of congestion. Next he checked the area of phlebitis and found it was all but resolved. With mounting anxiety David examined the rest of his patient. Finding nothing he hurried back to the nurses' station and ordered a barrage of stat laboratory tests.

The first thing to come back from the lab was her blood count, but it only added to David's puzzlement. Her white cell level, which had been appropriately falling with the resolution of the phlebitis, had continued to fall and was now in the lower percentile of normal.

David scratched his head. The low white count seemed contradictory to her clinical state, which suggested developing pneumonia. Getting up from the desk, David went back to Marjorie's room and listened to her chest again. The incipient congestion was real.

Returning to the nurses' station, David debated what to do. More lab tests came back, but they were all normal, even the portable chest X ray, and hence no help. David thought about calling in some consults, but after his poor utilization review the day before, he was reluctant. The problem was that the consults who might have been helpful were not part of the CMV organization.

Instead of requesting any consults, David took the Physicians' Desk Reference off the bookshelf. Since his main concern was that a gram-negative bacteria might have appeared as a super-infection, he looked up an antibiotic that was specific for such an eventuality. When he found one he felt confident it would take care of the problem.

After the appropriate orders were written, including a request to be called immediately if there was any change in Marjorie's status, David headed over to his office.

It was Angela's turn to handle the day's surgical frozen sections. She always found the task nerve-wracking since she knew that while she worked, the patient remained under anesthesia awaiting her verdict whether the biopsy was cancerous or benign.

The frozen sections were done in a small lab within the operating suite. The room was tucked off to the side and visited infrequently by the operating room staff. Angela worked with intense concentration, studying the patterns of cells in the specimen under the microscope.

She did not hear the door silently open behind her. She was unaware that anyone was in the room until he spoke.

"Well, honey, how's it going?"

Startled, Angela's head shot up as a bolus of adrenaline coursed through her body. With her pulse pounding in her temples, she found herself looking into Wadley's smiling face. She hated to be called "honey" by anyone, except maybe David. And she didn't appreciate being snuck up on.

"Any problems?" Wadley asked.

"No," Angela said sharply.

"Let me take a look," Wadley said, motioning toward the microscope. "What's the case?"

Angela gave Wadley her seat. Succinctly she gave the history. He glanced at the slide, then stood up.

For a moment they talked about the slide in pathological jargon. It was apparent they agreed the growth was benign, happy news for the anesthetized patient.

"I want to see you later in my office," Wadley said. He winked.

Angela nodded, ignoring the wink. She turned away and was about to sit down again when she felt Wadley's hand brush across her buttocks.

"Don't work too hard, honey!" he called out. And with that, he slipped out the door.

The episode had happened so fast that Angela had not been able to respond. But she knew it had not been inadvertent, and now she knew for certain that the thigh-touching the day before had not been an innocent oversight.

For a few minutes Angela sat in the tiny lab and trembled with indignation and confusion. She wondered what was encouraging this sudden boldness. She certainly had not changed her behavior over the last few days. And what should she do? She couldn't just idly sit by and allow it to go on. That would be an open invitation.

Angela decided she had two possibilities. She could confront Wadley directly or she could go to the medical director, Michael Caldwell. But then she thought about Dr. Cantor, the current chief of staff. Maybe she should go to him.

Angela sighed. Neither Caldwell nor Cantor struck her as ideal authorities to turn to in a case of sexual harassment. Both were macho types, and Angela remembered their responses when she'd first met them. Caldwell had seemed shocked that women were actually pathologists while Cantor had offered that ignorant remark about the few women in his medical school class being "dogs."

She thought again about confronting Wadley herself, but she didn't like that alternative any better.

The raucous buzz of static coming over the intercom shocked Angela back to reality. The static preceded the voice of the head nurse. "Dr. Wilson," she said. "They are waiting on the biopsy results down in OR three."

David found concentrating on his patients' problems harder that morning than the previous afternoon. Not only was he still upset about his review with Kelley, now he had Marjorie Kleber's worsening condition to worry about.

Midmorning, David saw another of his frequent visitors, John Tarlow, the leukemia patient. John didn't have an appointment; David had Susan squeeze him in as a semi-emergency after he'd called that morning. Only the day before David would have directed John to the ER, but feeling chastened by Kelley's lecture, he felt obliged to see the man himself.

John was feeling poorly. Following a meal of raw shellfish the night before, he'd developed severe GI problems with both vomiting and diarrhea. He was dehydrated and in acute discomfort with colicky abdominal pain.

Seeing how bad John was and remembering his leukemic history, David hospitalized him immediately. He ordered a number of tests to try to determine the cause of John's symptoms. He also started intravenous fluid to rehydrate him. For the moment he held off on antibiotics, preferring to wait until he had some idea of what he was dealing with. It could have been a bacterial infection or it could have been merely a response to toxins: food poisoning, in the vernacular.

Just before eleven in the morning Traynor was told the bad news by his secretary, Collette. She'd just been informed by phone that Jeb Wiggins had again carried the Board of Selectmen. The final vote on the hospital parking garage, which Traynor had managed once more to get on the agenda, had been thumbs down. Now there probably wasn't even a way to get it on the ballot again before spring.

"Goddamn it," Traynor raged. He pummeled the surface of his desk with both hands. Collette didn't flinch. She was accustomed to Traynor's outbursts. "I'd love to grab Wiggins around that fat neck of his and choke him until he turns blue."

Collette discreetly left the room. Traynor paced the area in front of his desk. The lack of support he had to deal with when it came to running the hospital galled him. He could not understand how the Board of Selectmen could be so shortsighted. It was obvious that the hospital was the most important enterprise in the entire town. It was equally obvious that the hospital needed the parking garage.

Unable to work, Traynor grabbed his raincoat, hat, and umbrella and stormed out of his office. Climbing into his car he drove up to the hospital. If there was to be no parking garage, he would at least personally inspect the lighting. He didn't want to risk any more rapes in the hospital parking lot.

Traynor found Werner Van Slyke in his windowless cubbyhole that served as the engineering/maintenance department's office. Traynor had never been particularly comfortable around Van Slyke. Van Slyke was too quiet, too much of a loner, and mildly unkempt. Traynor also found Van Slyke physically intimidating; he was several inches taller than Traynor and significantly huskier, with the kind of bulky muscles that suggested weightlifting was a hobby.

"I want to see the lights in the parking lots," Traynor said.

"Now?" Van Slyke asked, without the usual rise in the pitch of his voice that normal people use when asking questions. Every word he said was flat and it grated on Traynor's ears.

"I had a little free time," Traynor explained. "I want to make sure it's adequate."

Van Slyke pulled on a yellow slicker and walked out of the office. Outside the hospital he pointed to each of the lights in the lower lot, walking from one to the next without comment.

Traynor tagged along beneath his umbrella, nodding at each fixture. As he followed Van Slyke through the copse of evergreen trees and climbed the wooden steps that separated the two lots, Traynor wondered what Van Slyke did when he wasn't working. He realized he never saw Van Slyke walking around the town or shopping in the shops. And the man was notorious for not attending hospital functions.

Uncomfortable with the continued silence, Traynor cleared his throat: "Everything okay at home?" he asked.

"Fine," Van Slyke said.

"House okay, no problems?"

"Nope," Van Slyke said.

Traynor started feeling challenged to get Van Slyke to respond with more than monosyllables. "Do you like civilian life better than the navy?"

Van Slyke shrugged and began pointing out the lights in the upper lot. Traynor continued to nod at each one. There seemed to be plenty. Traynor made a mental note to swing up there with his car some evening to see how light it was after dark.

"Looks good," Traynor said.

They started back toward the hospital.

"You being careful with your money?" Traynor asked.

"Yeah," Van Slyke said.

"I think you are doing a great job here at the hospital," Traynor said. "I'm proud of you."

Van Slyke didn't respond. Traynor looked over at Van Slyke's wet profile with its heavy five o'clock shadow. He wondered how Van Slyke could be so unemotional, but then again he realized that he'd never understood the boy ever since he'd been little. Sometimes Traynor found it hard to believe they were related, yet they were. Van Slyke was Traynor's only nephew, the son of his deceased sister.

When they reached the stand of trees separating the two lots, Traynor stopped. He looked among the branches. "How come there are no lights on this path?"

"No one said anything about lights on the path," Van Slyke said. It was the first full sentence he had uttered. Traynor was almost pleased.

"I think one or two would be nice," Traynor said.

Van Slyke barely nodded.

"Thanks for the tour," Traynor said in parting. He was relieved to make his escape. He had always felt guilty for feeling so estranged from his own kin, but Van Slyke was such an enigma. Traynor had to admit that his sister hadn't exactly been a paragon of normality. Her name had been Sunny, but her disposition had been anything but. She'd always been quiet, retiring, and had suffered from depression for most of her life.

Traynor still had a hard time understanding why Sunny had married Dr. Werner Van Slyke, knowing the man was a drunk. Her suicide was the final blow. If she'd only come to him, he would have tried to help.

In any case, given Werner Van Slyke's parentage, it was hardly a surprise that he was as strange as he was. Yet with his naval machinist's training he'd been both helpful and reliable. Traynor was glad he'd suggested that the hospital hire him.

Traynor roused himself from this reflection and headed for Beaton's office.

"I've got some bad news," Traynor said as soon as Beaton's secretary admitted him. He told her about the Board of Selectmen's vote on the parking garage.

"I hope we don't have any more assaults," Beaton said. She was clearly disappointed.

"Me too," Traynor said. "Hopefully the lights will be a deterrent. I just walked around the parking lots and took a look at them. They seem adequate enough, except on the path between the two lots. I asked Van Slyke to add a couple there."

"I'm sorry I didn't do both lots from the start," Beaton said.

"How are the finances looking for this month?" Traynor questioned.

"I was afraid you'd ask," Beaton said. "Arnsworth gave me the mid-month figures just yesterday and they are not good. October will definitely be worse than September if the second half of the month is anything like the first. The bonus program is helping, but admissions for CMV are still over the projected level. To make matters worse, we seem to be getting sicker patients."

"I suppose that means we have to put more pressure on utilization," Traynor said. "DUC has to save the day. Other than the bonus program, we're on our own. I don't anticipate any more insurance bequests in the near future."

"There are a few other nuisances of which you should be aware," Beaton said. "M.D. 91 has relapsed. Robertson picked him up on a DUI. He was driving his car on the sidewalk."

"Pull his privileges," Traynor said without hesitation. "Alcoholic physicians have already caused enough heartache in my life." He recalled once again his sister's good-for-nothing husband.

"The other problem," Beaton said, "is that Sophie Stephangelos, the head nurse in the OR, has discovered significant theft of surgical instruments over the last year. She thinks one of the surgeons is taking them."

"What next?" Traynor said with a sigh. "Sometimes I think running a hospital is an impossible task."

"She has a plan to catch the culprit," Beaton said. "She wants an okay to go ahead with it."

"By all means," Traynor said. "And if she catches him let's make an example out of him."

Coming out of one of his examining rooms, David was surprised to find that the basket on the other room's door was empty.

"No charts?" he asked.

"You're ahead of yourself," Susan explained. "Take a break."

David took advantage of the opportunity to dash over to the hospital. The first stop was Nikki's room. When he walked in he was surprised to find both Caroline and Arni sitting on Nikki's bed. Somehow the two kids had managed to get into the hospital without being challenged. They were supposed to be accompanied by an adult.

"You won't get us into trouble, will you, Dr. Wilson?" Caroline asked. She looked much younger than nine. Her illness had stunted her growth much more than it had Nikki's. She looked more like a child of seven or eight.

"No, I won't get you in trouble," David assured them. "But how did you get out of school so early?"

"It was easy for me," Arni said proudly. "The substitute teacher doesn't know what's going on. She's a mess."

David turned his attention to his daughter. "I spoke with Dr. Pilsner, and he said it's okay for you to go home this afternoon."

"Cool," Nikki said excitedly. "Can I go to school tomorrow?"

"I don't know about that," David said. "We'll have to discuss it with your mother."

After leaving Nikki's room, David looked in on John Tarlow to make sure that he was settled, his IV was started, and the tests David had ordered were in progress. John said he didn't feel any better. David told him to be patient and assured him there'd be improvement after he'd been hydrated.

Finally David stopped in to see Marjorie. He hoped that the added antibiotic would have already improved her condition, but it hadn't. In fact, David was shocked to see how much she had deteriorated; she was practically comatose.

Panic-stricken, David listened to Marjorie's chest. There was more congestion than earlier but still not enough to explain her clinical state. Rushing back to the nurses' station, David demanded to know why he hadn't been called.

"Called on what?" Janet Colburn asked. She was the head nurse.

"Marjorie Kleber," David yelled while he wrote orders for more stat bloodwork and another portable chest X ray.

Janet consulted with several of the other floor nurses, then told David that no one had noticed any change. She even said that one of the LPNs had just been in Marjorie's room less than half an hour previously and had reported no change.

"That's impossible," David snapped as he grabbed the phone and started making calls. Earlier, he'd been reluctant to call in consults. Now he was panicked to get them to come in as soon as possible. He called Marjorie's oncologist, Dr. Clark Mieslich, and an infectious disease specialist, Dr. Martin Hasselbaum. Neither of them were CMV doctors. David also called a neurologist named Alan Prichard, who was part of the CMV organization.

All three specialists were available for David's call. When they heard David's frantic appeal and his description of the case, they all agreed to come in immediately. David then called Susan to alert her to what was happening. He told her to advise the patients who came into the office that he would be delayed.

The oncologist was the first to arrive, followed in short order by the infectious disease specialist and the neurologist. They reviewed the chart and discussed the situation with David, before descending en masse on Marjorie. After examining her closely they withdrew to the nurses' station to confer. But hardly had they begun to discuss Marjorie's condition when disaster struck.

"She's stopped breathing," a nurse yelled from Marjorie's room. She'd stayed behind to clean up the debris left by the examining specialists.

While David and the consults raced back, Janet Colburn called the resuscitation team. They arrived in minutes and converged on room 204.

With so much manpower immediately available, Marjorie was quickly intubated and respired. It had been done with such dispatch that her heart rate did not change. Everyone was confident she'd experienced only a short period of decreased oxygen. The problem was they did not know why she'd stopped breathing.

As they began to discuss possible causes, her heart suddenly slowed and then stopped. The monitor displayed an eerie flat line. The resuscitation team shocked her in hopes of restarting her heart, but there was no response. They quickly shocked her again. When that didn't work, they began closed chest cardiac massage.

They worked frenetically for thirty minutes, trying every trick they could think of, but nothing worked. The heart would not even respond to external pacing. Gradually, discouragement set in, and finally, by general consensus, Marjorie Kleber was declared dead.

While the resuscitation team unhooked their wires and the nurses cleaned up, David walked back to the nurses' station with the consults. He was devastated. He could not imagine a worse scenario. Marjorie had come into the hospital with a relatively minor problem while he was off enjoying himself. Now she was dead.

"It's too bad," Dr. Mieslich said. "She was such a terrific person."

"I'd say she did pretty well considering the history in the chart," Dr. Prichard said. "But her disease was bound to catch up with her."

"Wait a second," David said. "Do you think she died of her cancer?"

"Obviously," Dr. Mieslich said. "She had disseminated cancer when I first saw her. Although she'd done better than I would have predicted, she was one sick lady."

"But there wasn't any clinical evidence of her tumor," David said. "Her problems leading up to this fatal episode seemed to suggest some sort of immune system malfunction. How can you relate that to her cancer?"

"The immune system doesn't control breathing or the heart," Dr. Prichard said.

"But her white count was falling," David said.

"Her tumor wasn't apparent, that's true," Dr. Mieslich said. "But if we were to open her up, my guess is that we would find cancer all over, including in her brain. Remember, she had extensive metastases when she was originally diagnosed."

David nodded. The others did the same. Dr. Prichard slapped David on the back. "Can't win them all," he said.

David thanked the consults for coming in. They all politely thanked him for the referral, then went their separate ways. David sat at the nurses' station desk. He felt weak and disconsolate. His sadness and sense of guilt at Marjorie's passing was even more acute than he'd feared. He'd come to know her too well. To make it even worse, she was Nikki's beloved teacher. How would he explain this to her?

"Excuse me," Janet Colburn said softly. "Lloyd Kleber, Marjorie's husband, is here. He'd like to talk to you."

David stood up. He felt numb. He didn't know how long he'd been sitting at the nurses' station. Janet directed him into the patients' lounge.

Lloyd Kleber was staring out the window at the rain. David guessed he was in his mid-forties. His eyes were red from crying. David's heart went out to the man. Not only had he lost a wife, but now he had the responsibility of two motherless children.

"I'm sorry," David said lamely.

"Thank you," Lloyd said, choking back tears. "And thank you for taking care of Marjorie. She really appreciated your concern for her."

David nodded. He tried to say things that reflected his compassion. He never felt adequate at moments like this, but he did the best he could.

Finally, David ventured to ask for permission to do an autopsy. He knew it was a lot to ask, but he was deeply troubled by Marjorie's swift deterioration. He wanted desperately to understand.

"If it could help others in some small way," Mr. Kleber said, "I'm sure Marjorie would want it done."

David stayed and talked with Lloyd Kleber until more members of the immediate family arrived. Then David, leaving them to their grief, walked over to the lab. He found Angela at the desk in her office. She was pleased to see him and told him so. Then she noticed his strained expression.

"What's wrong?" she asked anxiously. She stood up and took his hand.

David told her. He had to stop a few times to compose himself.

"I'm so sorry," Angela said. She put her arms around him and gave him a reassuring hug.

"Some doctor!" he chided himself, fighting tears. "You'd think I'd have adjusted better to this kind of thing by now."

"Your sensitivity is part of your charm," Angela assured him. "It's also what makes you a good doctor."

"Mr. Kleber agreed to an autopsy," David said. "I'm glad because I haven't the slightest idea why she died, especially so quickly. Her breathing stopped and then her heart. The consults all think it was her cancer. It probably was. But I'd like Bartlet to confirm it. Could you see that it gets done?"

"Sure," Angela said. "But please don't get too depressed over this. It wasn't your fault."

"Let's see what the autopsy shows," David said. "And what am I going to tell Nikki?"

"That's going to be hard," Angela admitted.

David returned to his office to try to see his patients in as short order as possible. For their sake, he hated being so backed up, but there had been no way to avoid it. He'd only managed to see four when Susan waylaid him between examining rooms.

"Sorry to bother you," she said, "but Charles Kelley is in your private office, and he demands to see you immediately."

Fearing Kelley's visit had something to do with Marjorie's death, David stepped across the hall into his office. Kelley was impatiently pacing. He stopped when David arrived. David closed the door behind himself.

Kelley's face was hard and angry. "I find your behavior particularly galling," he said, towering over David.

"What are you talking about?" David asked.

"Just yesterday I spoke with you about utilization," Kelley said. "I thought it was pretty clear and that you understood. Then today you irresponsibly ordered two non-CMV consults to see a hopelessly terminal patient. That kind of behavior suggests that you have no comprehension of the major problem facing medicine today: unnecessary and wasteful expense."

With his emotions raw, David struggled to keep himself under control. "Just a minute. I'd like you to tell me how you know the consults were unnecessary."

"Oh, brother!" Kelley said with a supercilious wave of his head. "It's obvious. The patient's course wasn't altered. She was dying and she proceeded to die. Everyone must die at some time or another. Money and other resources should not be thrown away for the sake of hopeless heroics."

David stared into Kelley's blue eyes. He didn't know what to say. He was dumbfounded.

Hoping to avoid Wadley, Angela sought out Dr. Paul Darnell in his windowless cubicle on the other side of the lab. His desk was piled high with bacterial culture dishes. Microbiology was his particular area of interest.

"Can I speak to you for a moment," Angela called from Paul's doorway.

He waved her in and leaned back in his swivel chair.

"What's the autopsy protocol around here?" she asked. "I haven't seen any done since I got here."

"That's an issue you'll have to discuss with Wadley," Paul said. "It's a policy problem. Sorry."

Reluctantly, Angela went to Wadley's office.

"What can I do for you, honey?" Wadley said. He smiled a kind of smile Angela had previously seen as paternal but now saw as lewd.

Wincing at being addressed as "honey," Angela swallowed her pride and asked about the procedure for arranging an autopsy.

"We don't do autopsies," Wadley said. "If it's a medical examiner case, the body goes to Burlington. It costs too much to do autopsies, and the contract with CMV doesn't include them."

"What if the family requests it?" Angela asked, knowing this wasn't precisely true in the Kleber case.

"If they want to shell out eighteen hundred and ninety dollars, then we'll accommodate them," Wadley said. "Otherwise, we don't do it."

Angela nodded, then left. Instead of getting back to her own work, she walked over to the professional building and went into David's office. She was appalled by the number of patients waiting to be seen. Every chair in the waiting room was occupied; a few people were even standing in the hall. She caught David as he shuttled between examining rooms. He was clearly frazzled.

"I can't do an autopsy on Marjorie Kleber."

"Why not?" David asked.

Angela told him what Wadley had said.

David shook his head with frustration and blew out between pursed lips. "My opinion of this place is going downhill fast," he said. He then told Angela about Kelley's opinion of his handling of the Kleber case.

"That's ridiculous," Angela said. She was incensed. "You mean he suggested that the consults were unnecessary because the patient died. That's crazy."

"What can I tell you?" David said with a shake of his head.

Angela didn't know what to say. Kelley was beginning to sound dangerously uninformed. Angela would have liked to talk more, but she knew David didn't have the time. She motioned over her shoulder. "You've got an office full of patients out there," she said. "When do you think you'll be done?"

"I haven't the slightest idea."

"How about I take Nikki home and you give me a call when you're ready to leave. I'll come back and pick you up."

"Sounds good," David said.

"Hang in there, dear," Angela said. "We'll talk later."

Angela went back to the lab, finishing up for the day, collected Nikki, and drove home. Nikki was ecstatic to get out of the hospital. She and Rusty had an exuberant reunion.

David called at seven-fifteen. With Nikki comfortably ensconced in front of the TV, Angela returned to the hospital. She drove slowly. It was raining so hard the wipers had to struggle to keep the windshield clear.

"What a night," David said as he jumped into the car.

"What a day," Angela said as she started down the hill toward town. "Especially for you. How are you holding up?"

"I'm managing," David said. "It was a help to be so busy. I was grateful for the diversion. But now I have to face reality; what am I going to tell Nikki?"

"You'll just have to tell her the truth," Angela said.

"That's easier said than done," David said. "What if she asks me why she died? The trouble is I don't know, neither physiologically nor metaphysically."

"I've thought more about what Kelley said," Angela said. "It seems to me he has a fundamental misunderstanding about the basics of patient care."

"That's an understatement," David said with a short, sarcastic laugh. "The scary part is that he's in a supervisory position. Bureaucrats like Kelley are intruding into the practice of medicine under the guise of health-care reform. Unfortunately the public has no idea."

"I had another minor run-in with Wadley today," Angela said.

"That bastard!" David said. "What did he do now?"

"He called me 'honey' a few times," Angela said. "And he brushed his hand across my backside."

"God! What an insensitive jerk," David said.

"I really have to do something. I just wish I knew what."

"I think you should talk to Cantor," David said. "I've given it some thought. At least Cantor is a physician, not just a health-care bureaucrat."

"His comment about 'the girls,' as he called them, in his medical school class was not inspiring," Angela said.

They pulled into their driveway. Angela came to a stop as close as possible to the door to the mud room. They both prepared to run for shelter.

"When is this rain going to stop?" David complained. "It's been raining for three days straight."

Once they were inside, David decided to make a fire to cheer up the house while Angela reheated the food she'd made earlier for herself and Nikki. Descending into the basement, David noticed that moisture was seeping through the grout between the granite foundation blocks. Along with the moisture was the damp, musty odor he'd occasionally smelled before. As he collected the wood, he comforted himself with the thought of the earthen floor. If a significant amount of water were to come into the basement, it would just soak in and eventually disappear.

After eating, David joined Nikki in front of the TV. Whenever she was ill they were lenient about how much time she was allowed to watch. David feigned interest in the show in progress, while he built up the courage to tell Nikki about Marjorie. Finally, during a commercial break, David put his arm around his daughter.

"I have to tell you something," he said gently.

"What?" Nikki asked. She was contentedly petting Rusty who was curled up on the couch next to her.

"Your teacher, Marjorie Kleber, died today," David said gently.

Nikki didn't say anything for a few moments. She looked down at Rusty, pretending to be concerned about a knot behind his ear.

"It makes me very sad," David continued, "especially since I was her doctor. I'm sure it upsets you, too."

"No, it doesn't," Nikki said quickly with a shake of her head. She brushed a strand of hair away from her eyes. Then she looked at the television as if she were interested in the commercial.

"It's okay to be sad," David said. He started to talk about missing people you cared about when Nikki suddenly threw herself at him, enveloping him in a flood of tears. She hugged him tighter than he could ever remember her having hugged him.

David patted her on the back and continued to reassure her.

Angela appeared at the doorway. Seeing David holding their sobbing child, she came over. Gently pushing Rusty aside, she sat down and put her arms around both David and Nikki. Together the three held onto each other, rocking gently as the rain beat against the windows.