Читать книгу The Nurse's Pregnancy Miracle - Ann McIntosh - Страница 12

CHAPTER FOUR

THERE WAS SOMETHING a little off about David Warmington today, but Nychelle couldn’t put her finger on it. Perhaps it was that for the first time she sensed he was growing ever more irritated with a patient.

Not that she could blame him. Douglas Comstock, a sports agent referred to the clinic by one of his star clients, was being willfully difficult. He’d come in complaining of persistent leg pain, and after examining him she’d sent him for X-rays and a MRI. He had requested pain medication, because over-the-counter painkillers were no longer working, and since nurse practitioners weren’t allowed to prescribe medication Nychelle had requested one of the GPs see him. David had been available.

Now she was being treated to a battle of wills, her head swiveling back and forth between the two men as though she were at a debate. It would be entertaining if it weren’t for the fact she was sure David was having a hard time dealing with this patient.

As she watched, it seemed David took a deeper than necessary breath before saying, “Mr. Comstock—”

“Doug.” The man grinned, totally at ease. Almost seeming to be enjoying himself. “Call me Doug, Doc.”

“Doug. I’m going to refer you to Dr. Napoli, who is one of the best orthopedic surgeons in Florida. But, I’m telling you, she’s not going to be able to help you until you lose some weight.”

Doug Comstock was still smiling, even as he shook his head. “Don’t bother sending me to anyone else. Just give me some meds, Doc, and I’ll be on my way. As I was telling Nychelle, that losing weight thing’s probably just not going to happen. I’m on the road for most of the year, traveling with the athletes I manage, and I don’t have time to add anything else to my schedule, you know?”

He made the argument sound reasonable, but David was having none of it.

“No,” he countered. “I don’t know. Explain to me how eating healthier and getting exercise are going to disrupt your schedule.”

“Sure, Doc.”

Doug kept right on smiling, and Nychelle realized it was probably part of the reason he was successful. It was an effective way to rebuff almost any dissent.

“I’m at sporting events most nights, or out scouting new talent. Then there are after-parties or press conferences. Even if there are no events there are dinners, where I’m schmoozing prospective clients or dealing with owners. I’m up with the birds, on the phone making connections, setting things up, talking to people on the other side of the world. Then I’m taking people to lunch, or sitting around in meetings most of the day. My day is long, and as full as you can get, and it involves a lot of eating and drinking to boot. Add one more thing into that and I have to drop something else. What do you suggest? The three or four hours of sleep I get a night?”

While his pleasant expression hadn’t changed, there was a steely tone in his voice. He obviously wasn’t used to being lectured or opposed, but once more David didn’t back down.

“I see from the chart Nurse Cory tried to schedule you for some tests, but you told her not to set them up.”

“Yup.” Doug shifted on the table, lifting one beefy leg and then the other, obviously uncomfortable although his smile remained in place. “I’m heading to Taiwan in three days, so it doesn’t make sense for her to bother. I won’t make the appointments anyway.”

David glanced at Nychelle and she gave him a quick upward quirk of her eyebrows. A silent good luck. Then David gave Doug a thoughtful look. Normally by now he should be telling the patient to put on his clothes and come into the adjacent office, where they could sit and discuss the situation in comfort. Instead, perhaps to underscore the importance of what he had to say, David launched right in.

“Okay, Mr. Comstock. I know I should probably be more tactful, but I don’t think you’ll take me seriously. So I’m going to give this to you straight.”

Was that a slight wavering of the smile on their patient’s face? Nychelle couldn’t be sure, but she hoped so. It might mean the other man was really listening.

“You’re at least a hundred pounds over the optimal weight for your height and bone structure. I suspect, from the X-rays and MRI results, that you may have a herniated disc, which accounts for the leg pain, and the numbness and weakness you’re experiencing. While there are treatments that could help with the pain, those are best explored with a specialist like Dr. Napoli. Realistically, though, the treatment is probably going to be ineffective if you don’t address the root causes of the problem. And pain medication on its own will only mask the symptoms.”

“But—”

David gave the man a stern look and held up one hand. “Wait, please. Let me finish.”

Smile totally gone, Doug gave a little huff of clear annoyance, but subsided.

“Perhaps even more important, even at your age, your weight puts you at risk for so many other diseases. Ones that can halt you right in your busy tracks.”

He glanced down at the tablet in his hand, maybe to give his words a chance to sink in, then continued.

“Your blood pressure is elevated, and although you’re on the appropriate medication you say you haven’t been to a doctor in a few years, so I suspect your management of that hasn’t been tracked, nor your medication adjusted. Uncontrolled blood pressure can lead to a stroke.”

Doug’s eyes widened slightly, but David pressed on, relentless in a way she suspected he normally wouldn’t be. Seeing him like this was a little surreal.

And surprisingly attractive.

She shook that thought away, but not before a little tingle had tiptoed down her spine.

“You’re also at an elevated risk for diabetes—which, should you develop it, would definitely add new tasks to your daily routine, such as taking your blood sugar levels three times a day and giving yourself injections of insulin to ensure you don’t go into a diabetic coma.”

Doug Comstock paled. His lips parted, but then he looked down and closed them again. David waited and then, assured the other man wouldn’t interrupt, he continued.

“Nurse Cory has noted you’ve had some breathing issues, which could be something as simple as a reaction to air quality or as serious as imminent congestive heart failure. I’m also concerned about your cholesterol levels, considering your lifestyle, but there is no way to know whether you should be worried about either of those matters without further tests. Furthermore, your excess weight, as well as putting undue pressure on your back, is also putting immense pressure on your other joints, so you can expect to begin experiencing knee, hip and/or ankle problems. Also, with all the traveling you do, you are definitely at risk for deep vein thrombosis. Do you know what that is?”

A now somber Doug shook his head. David definitely had his attention now, thank goodness.

“That is when blood clots form in your legs, which can then travel through the veins and cause a pulmonary embolism—a blockage in your lungs. You have two of the major risk factors—you sit down a lot, and you’re overweight.”

Sensing the patient’s rising anxiety, Nychelle stepped closer, and said, “Mr. Comstock, I know it seems like a real inconvenience to try to lose weight, or to concentrate on your health when you have so much going on, and so many people depending on you, but we can help. Make it achievable without adding too much fuss to your day.”

She smiled, hoping to soften the words. It was like playing “good cop, bad cop,” and if it would help to get the patient on the right track, she was willing to go with it.

“I...” Doug Comstock frowned, then looked down again at his hands, where they lay on his thighs. “I guess I can at least try. I haven’t been feeling so good lately, and I’m not sleeping well, but I just put it down to the pain.”

David opened his mouth, and Nychelle hoped he wouldn’t bring up any of the other myriad conditions obesity might be causing the patient, like sleep apnea. There was no point in overloading Doug with what ifs and risk him shutting down. Not now, when he seemed amenable to letting them guide him to a healthier way of life.

But instead David said, “Why don’t you put on your clothes and come through to the office? We’ll get you scheduled for some blood tests—many of which we can do right now, before you leave—and Nurse Cory and I will set you up with a plan to get you on the right track.”

“Okay. Okay.” Doug heaved himself off the table. “I’ve only gotten this big in the last six years, since my management business took off, believe it or not.”

“That’s actually good,” David said. “It’s not the habits of a lifetime you’re trying to break, just those you’ve developed over a short space of time. I think, for a man of your drive and character, this will be a breeze.”

And Doug, thankfully, was smiling again as David and Nychelle left the room.

* * *

David was hard pressed to remember when last he’d been so annoyed with a patient and, given the thoughtful look Nychelle sent him as they entered her office, he guessed he hadn’t hidden it very well.

“Whew,” Nychelle said quietly, after making sure the door to the examination room was firmly closed. David was already on the defensive, even before she said, “I’m glad you got through to Mr. Comstock, but you were pretty hard on him.”

“He needed me to be.”

He realized how much of a growl that had been when Nychelle glanced at him again, her eyebrows raised.

But all she said was, “Apparently. I said a lot of the same things to him and all he did was brush me off. I was a little worried he was prescription shopping, when he kept insisting all he needed were painkillers.”

As she crossed to the credenza where she kept various informational brochures, David went to sit at her desk and blew out a long breath.

“At least we cleared up that misapprehension, but I honestly have no idea whether he’ll actually listen to us and try to make the changes we suggest.” He pulled the laptop closer to bring up the necessary records. “Sometimes I wonder why we bother.”

Pausing in the midst of pulling pamphlets from a drawer, Nychelle sent him a steady look over her shoulder. “It can frustrating at times, I know.” Turning back to her chore, she asked, quietly, “Everything okay?”

“Yes.” Yet, he could hear the lie in his voice—feel it in the jagged ache that fired through his chest. “I’m fine.”

Thankfully she didn’t reply immediately, allowing him to continue selecting the tests he wanted the patient to undergo on the electronic form. It was easier to concentrate on that than to think about what today meant, or let Nychelle’s instinctive kindness undo all the emotional barriers he’d marshaled to get him through the day.

He didn’t look up from the computer screen when she came across to the desk, not even when she said, “Well, if you need anything—an ear, or a hand—just let me know.”

Her compassion was almost his undoing, and he was thankful when the door to the exam room opened and Douglas Comstock came in to join them.

After Nychelle had taken their rather subdued patient off to have some of the tests run, David made his way back to his own office. Dropping into his chair, he scrubbed both hands over his face, as though to awaken himself from the aching sorrow wrapped around him like a pall. He should have taken the day off, but the thought of being at home without anything to do had had zero appeal, and there was nowhere he could think of going that would have been any better. Work seemed the best way to deal with the pain.

How tempted he’d been to tell Nychelle what today was. Something in her empathetic gentle gaze, the timbre of her voice, had made him want to share with her that which he never shared. Had never been tempted to share, neither wanting to worsen the wound nor, conversely, diminish the loss. As if saying the words Today was the day my baby girl, my Natalie, was born way too early and didn’t survive would be a betrayal of the love he still felt ten years later.

She had been born at just shy of twenty weeks. As a doctor he would call it a miscarriage or, worse, a spontaneous abortion. As a man, Natalie’s father, he couldn’t bring himself to think of it that way. It was simply her birthday, the day he’d truly learned, for the first time, what love was. And it was also the day he’d learned the immensity of the agony love could cause. The irrevocable, heartbreaking loss hadn’t become easier to bear over time. Probably never would.

Taking a breath, he held it for a moment and then blew it out. Leaning back in his chair, he wished he were still in Chicago so he could visit her grave, the way he had every other year. When he’d been offered the job in Florida he’d thought about moving away from her and almost refused. Yet he’d known it was time to move on—not from her, but in his professional life. He’d reassured himself he didn’t need to be there to remember her, to miss her, but he hadn’t realized how bad today would be, the pain magnified by distance and the strangeness of his new life.