The next day, Friday, Tricia was up early, her head still swimming from the revelations of the night before. Though she’d been excited at the prospects of building a new life in Spearfish Lake, and as nice as people had been to her, she’d seen enough of Dr. Luce’s practice to know it was a mess, and some of the problems had seemed almost insurmountable.

She had little doubt that she could improve the medical care given to the patients; in fact, it wouldn’t be any big trick. But the business side . . . from what little she’d seen, it looked to be a nightmare. Or worse. She’d known she didn’t have the business knowledge or experience to even have an idea of where to start fixing it, but, like she’d told Ryan Clark and the group the night before, she was willing to wade into the problem and do the best she could. She hadn’t expected it to be easy, but it was clear it was going to have to be done, one way or another.

But then, to discover that the foundation people had already seen the problem and were taking steps to deal with it . . . that was unexpected, to say the least. Now she would only have to put relatively minor attention to the business issues and would be free to concentrate on medical problems. She could do that.

There was a price to pay in doing that, of course, and she’d seen the fish hook early on. For that matter, Ryan had even pointed it out to her: even if she built the practice up – and there was no reason she shouldn’t be able to – it wouldn’t really be her practice to sell. Well, that was fine with her; it was a reasonable price to pay in order to not have to purchase it herself, along with the other benefits. If she wound up staying in Spearfish Lake it wouldn’t matter anyway, but it clearly was an obvious inducement for her to stay longer than the five years of her contract.

Last night had certainly put a different spin on things, and the prospects seemed exciting. She even got up and had breakfast a little early; while she was waiting, she asked the waitress for directions to the old hospital and took a few minutes to drive by the place. Though she never got out of the Neon, she could see the single-story cut stone building looked a little empty and forlorn – but offered promise. The fruition of Gene’s idea could be a year or more off, but if it worked out a lot of things could be better.

For the third morning in a row she walked into Spearfish Lake Hardware and Appliance, and for the second morning in a row it was with a big smile on her face. “You know, Danny,” she grinned, “we’re going to have to stop meeting like this every morning or people are going to start to wonder.”

“Shouldn’t have to much longer,” he grinned back. “All you have to do is sign some paperwork and give me a key to the place. I should be able to get most everything over there and set up today. Drapes have to wait till tomorrow, although Daphne promises she’ll have them ready for you by then, and I’ll get them up as soon as they’re ready.”

“God, Danny, you really are a jewel, you know that? I can’t imagine people being this helpful.”

“Has to be that way,” he shrugged. “A small-town store like this can’t compete with the big box stores down in Camden on price, but we can beat the living hell out of them on convenience and service. I’ve understood that since I was a little kid. At least some people understand that there’s more to life than bottom-feeding prices. Come to think of it, it’s probably true for small-town doctors, too.”

“I’m sure you have to be right,” she nodded, “but I’m going to have to learn how to do it in practice. Let’s face it, my residency experience was in a large city clinic, and patient convenience wasn’t exactly the top priority.”

“Now that I’ve pointed it out, I don’t think I need to say any more about it,” he smiled, “other than to say that you always need to keep it in mind.”

An image crossed her mind. She really shouldn’t say it, she thought, but it was too good to pass up, and Danny was the only one she could say it to. She glanced around to make sure no one else was in the store, then grinned at him and spoke in a little lower voice. “I mean, good god, can you imagine the Redlite with a waiting room, with only Redbook and Highlights for Children to read, the girls on an appointment basis and always running two hours behind?”

Danny broke out laughing. “You’d have people on the road to one of the houses over in Pahrump so quick it wouldn’t be funny,” he managed to say after a moment. “But it’s exactly what I meant. Look, sometimes shit happens. Sometimes it even happened at the Redlite, and people there understood it, just like they understand that it happens around a doctor’s office. But it shouldn’t be the normal thing. Do you realize why Dr. Luce still has a practice at all?”

“Well, it’s like Gene was saying last night, there’s too much work for one doctor.”

“Yeah, but he didn’t say all of it. Shovelhead is a nice guy, but he’s always so goddamn busy that you pretty well described what being a patient of his is like. The only time he’s not running two hours behind is first thing in the morning. He tries to keep up, and usually that involves a sandwich on the fly for lunch and working a couple hours late, sometimes more. Some people don’t like that, so they go to Dr. Luce, where they can usually get in and get right back out again, no matter the lower quality of care. The alternative is an hour’s drive down to Camden, a wait there, and an hour’s drive back.”

“So it’s no improvement.”

“Yeah.” He took a deep breath, obviously trying to phrase what he wanted to say, then went on with what he was saying. “The hell of it is that while Shovelhead is a good doctor and tries to give the patients the care they deserve, he’s so goddamn rushed all the time that he probably misses stuff, too. In time, your being here is going to improve his patient care, too. That’s part of the reason he’s wanted to get someone up here so badly.”

Tricia stood and thought about it for a moment. “I guess I never thought about it that way,” she replied finally. “But it makes sense.”

“It makes a lot of sense,” Danny said. “Look, another thing that wasn’t said last night was that the steering committee or whatever the hell it could be called has been informally kicking around the notion of doing another doctor search, just like they did with you. It’s not because they don’t think you’re going to make a big improvement, but that two doctors may still not be enough. However, right at the moment it’s a case of wait and see what happens first. It may turn into a search for a nurse practitioner or physician’s assistant or two, but like Shovelhead said last night, it’s harder to offer the kind of incentives that can be offered to a physician.”

“Danny,” she frowned. “You knew a lot of that stuff they talked about last night. Why didn’t you tell me? I mean, at least give me a heads up?”

“Mostly because it wasn’t my place to tell you,” he said. “After all, to most people I’m just a furniture salesman to you, and we officially don’t know each other more than that. Besides, it was Ryan’s thing to say, not mine, and I knew he wanted to present it his way. He was probably right on that. He and Shovelhead have mostly been the ones behind this. I had to monitor things as a representative of the Walworth Foundation and the chamber, and I’ve learned a hell of a lot in the process, but really I haven’t been much more than a spear carrier.”

“Yeah, but Danny, whether we are officially friends or not, you’re still a friend, and you’ve been able to give me some perspective on a few things.”

“We’re just going to have to become officially friends a little. Like I said the other night, since I’m also the chamber president, Debbie and I really ought to have you over for dinner sometime soon. Do that a couple times and we can be a little more open with each other in public.”

There was a little more running to do, but not much, things like arranging for water, electricity, gas, phone, and internet at her house before she headed back to Dr. Luce’s office. There was only one person, a heavy-set older man, waiting in the waiting room when she walked in, not surprising since there rarely had been very many people waiting. After Danny’s comments earlier, why that was so was much more understandable; some people just didn’t have the patience to sit around for hours on end waiting for a few minutes with a doctor, and that couldn’t be to their benefit.

“I’m back,” she told Betty. “What can I do today?”

“Don’t know,” Betty grunted. “Doctor should be done with his patient in a few minutes. He said he wanted to talk to you as soon as you got in.”

It didn’t take long to see Dr. Luce. “So how are you this morning?” he asked, in what seemed to be a good mood for him.

“Not bad. Things are starting to get organized.” She figured she didn’t need to say anything more than that, especially about the meeting the night before.

“Are you getting your apartment thing under control?”

“I think so,” she said. “The guy down at Spearfish Lake Furniture and Appliance said he could deliver most of the furniture today, and the draperies tomorrow. I just told him to put things where he thought they should go, and I can change them when I get to it.”

“I never had cause to deal with the young Evachevski, but his father was always pretty good,” Dr. Luce nodded. “I expect you’re getting treated right.”

“I have no complaints so far,” she smiled. “There are still going to be things I need to do like dishes and groceries, but I can deal with them as I need to. I should have time, after all.”

“Maybe not as much time as you’d like,” he said. “Look, Dr. York. I’d hoped to have a little more time to ease you into the practice, but I had a call from Ryan Clark this morning. You know him?”

“I’ve met him,” she replied, choosing her words carefully. “He was on the interview committee that set me up to come here.”

“Good man, done a lot for the town,” Dr. Luce smiled. “He runs the Donna Clark Foundation, that’s the outfit that set it up, and they’re providing the cash to set you up, but I suppose you knew that.”

“I did,” she nodded. “They’ve been very helpful.”

“Wouldn’t expect less of a man like Ryan Clark,” he said. “Anyway, he called me this morning and asked if I’d be willing to turn the practice over to you a week from tonight. Like I said, I wouldn’t have minded having a little more time to ease you into it, but I’m willing if you’re willing.”

“It seems a little quick to me, too,” she said in a little white lie. “But I can do it if it’s okay with you.”

“We might as well, then,” he nodded. “At least it’s going to be a little better than if you had to walk into the practice cold, like if I’d died on you or something. I’ll call him back and tell him we’ve worked it out.”

“I’d appreciate it, Dr. Luce, thank you.”

“Now, I’ve had a few minutes to think about it, and I think maybe I ought to let you get your hands on the steering wheel while I’m still here, so you’ll be able to ask questions while I’m around to answer them. I’m thinking I might as well let you start seeing patients right now. I can just hang around in case there’s something I can answer. I can spend my time cleaning out my desk or something.” He let out a sigh and shook his head. “I’ve never had to do this before, so I’m not sure how to go about it, but I guess we’re just going to have to do the best we can.”

“I’ll try to make it work,” she smiled. “It’ll be good to have you available for a while, though.”

In only a few minutes she was seeing her first patient in the practice on her own – the older man she’d seen in the lobby. “Hi, Mr. Christiansen. I’m Dr. York,” she introduced herself with a smile, using his name she got from his record. “I’m in the process of taking over Dr. Luce’s practice.”

“That’s gonna seem strange,” Mr. Christiansen replied with a smile. “I mean, to have a nice young lady like you around here rather than an old coot like Doc Luce.”

“It’s probably going to seem strange to a lot of people, and I’m sure I’ll be one of them,” she replied in a teasing tone, then got more serious. “So what’s the problem today?”

“My eyesight went to hell the last couple days. Everything went fuzzy, oh, night before last. I can’t see shit, especially after dark. I wouldn’t think my eyes would go bad that quickly.”

“Well, let’s check you over a bit,” she smiled. She did the usual things an office nurse would have done had there been one available, like taking a blood pressure – 160 over 100, more than a little on the high side, and something that needed to be addressed, but it wouldn’t necessarily contribute to a quickly appearing vision problem.

She glanced at his record, which was hard to make out because it was all done in handwriting, and bad doctor’s handwriting at that. It was pretty vague, but she could make out that blood pressures had been high for a long time, and she could more or less figure out what meds had been used to try to control it. No big flags there, but she thought she could make out of Dr. Luce’s handwriting, “complains of problem urinating.” No detail, though. In her mind, that was a big red flag!

“Mr. Christiansen,” she said. “I see a mention of problems urinating. Is that still the case?”

“Oh, yeah, shit,” he sighed. “Seems like I gotta piss real bad every fifteen minutes, but there ain’t never a lot.”

“Are you thirsty a lot?”

“Yeah, seems like I have to drink something every fifteen minutes or so too.”

“Has this gone on long?”

“It’s been gettin’ worse for a couple years.”

By now it was more than just flags waving in Dr. York’s mind; there were alarm bells going off there, too. “Let me check something,” she said. “I shouldn’t be long.”

She went back out into the hall, and right down to Dr. Luce’s office. “Dr. Luce,” she asked, “Do we have a blood glucometer around here somewhere?”

“Yeah, there should be one in the cabinet down at the end of the hall,” he said. “Middle drawer, I think.”

It only took a moment to find it, but a little longer to recognize it – it was an old one, probably ten years out of date, maybe more. She hit the “test” button and saw that the batteries were working though. She took it back to the examining room, along with a lancet and a test strip. “I want to run a quick check on something, so I’ll need to get a drop of your blood. This won’t hurt much.”

The glucometer was old enough that it took almost a minute to run its test. The LCD screen flashed 537; in smaller block letters a word was flashing: KETONES?

It didn’t really surprise her. He was showing plenty of symptoms of being an uncontrolled Type II diabetic, and had many of the markers. The really irritating thing was that with his complaint of difficulty urinating, it should have been noticed a long time before! And the difficulty urinating might be indicative of other problems. She glanced at the records again, to find no sign of a PSA that she could see – and that was about the first thing that should be done for older men with that complaint.

Right at the moment, she was god damn glad Dr. Luce was leaving! If she could manage it discreetly, she’d see that he never saw a patient again, at least without her oversight!

She took a couple deep breaths, mostly to get her temper under control. “I think you have a problem,” she said, as gently as possible. “I need to get a couple more tests done, but it wouldn’t surprise me if you had Type II diabetes.”

“Guess it wouldn’t surprise me either,” Mr. Christiansen replied. “My sister’s had it for years.”

Shit! A family history of it too, and no mention of it she could see in his record! How in the hell . . . She hadn’t asked about it since she’d seen all the flags she’d needed to already. “If I’m right, and I’m pretty sure I am, you’re going to have to deal with it the rest of your life,” she told him. “But if we can get it under control, there’s no reason you can’t live with it for a long time.”

“Am I gonna have to take insulin shots like my sister?”

“I can’t tell yet,” she replied. “You may, and you may not. We may be able to hold them off for a while, perhaps years. I’ll tell you right now, there are things that will make it easier. You really need to hold down eating carbohydrates as much as possible, and avoid sugar like it was poison. For you, it is.”

“Aw, shit,” he shook his head. “I guess that means I gotta cut out stuff I like, like my wife’s pies.”

“There are ways to make it a little easier,” she said. “But one of the things that would help if you would lose some weight. I don’t know if there are any low-carbohydrate diet handouts around here but I’ll look and see. For now, I want to get those tests run. I’m going to give you a prescription for some pills that will probably help. At the same time, I’ll give you a script for a glucometer and test strips, sort of like this one. I want you to test yourself every morning right after you get up, and keep a record. The people at the pharmacy should be able to show you how to use it. If they can’t, come back here and I will, but it’s pretty much what I just did.”

“My sister ought to be able to do it, too.”

“Your sister ought to have a pretty good idea of what you’ll be going through. Now, I want you to schedule another appointment in about a week. We’ll see how the pills are helping you, and if the tests show indications of other problems. Unfortunately, it’s going to take a few days to get the lab results back from Camden, the first of the week at the earliest.”

“How about my vision?”

“You’re going to have to put up with it for a while, but it’s probably the result of your blood sugar being very high for an extended period. If we can get your blood sugar back under at least a little control, it should slowly improve back to normal. It may take four to six weeks. I’m new enough here that I don’t know if there are any diabetic education classes available, but if there aren’t I’ll do them myself. I’ll just say that low blood sugar can be just as bad as high blood sugar, but it can kill you a lot more quickly. I don’t think that’s going to be a problem for the next few days though. If we can get your blood sugar under control it should clear up a lot of your urination problem, too. There may be another problem there, one I don’t know about, and we won’t know more till I get the test results back.”

“Well, good,” he said. “This having to piss all the time, it’s a pain, well, I can’t say pain in the ass, can I? It sure ain’t no fun, though.”

“We’ll have to keep after it and see if blood sugar is the only problem. But since you mentioned it, I do need a urine specimen, and I’ll want to get a better blood sample to send to the lab.”

“I can sure help you with the urine specimen,” he smiled. “In fact, I got to go so bad it ain’t funny.”

“Go down the hall and do it,” she said, handing him a specimen cup. “I’ll write up some scripts for you while I’m waiting and do the blood draw when you get back.”

In a few more minutes she was done with Mr. Christensen. It was too early to tell how easy it was going to be to get his problem under control, but at least now they could make an attempt at it. It had been an important lesson for her, though: go over every patient carefully, no matter how miniscule the problem. There were going to be times, perhaps a lot of times, that the records weren’t going to be of a lot of use. At least for the time being the patient load might be light enough she’d have the time to do it.

The next couple patients were a little more routine, although she took the time to do a careful examination and update histories. At least no obvious major problems jumped out at her. She was bringing the paperwork back out on one of them when Betty told her, “Dr. York, you had a call from Danny down at the furniture store. Some kind of problem with some of your furniture, I guess, but he said it wasn’t urgent.”

“Good, I’ll call him back when I get a chance.”

“Got time now; we don’t have anyone waiting.”

“OK, fine,” she said. “You wouldn’t happen to know the number, would you?”

Betty handed her a pink call-back slip, and Tricia sat down at the unoccupied desk in the front office to use the phone. In seconds Danny was on the phone. “Mr. Evachevski,” she said, figuring the walls had ears, “This is Doctor York. I was told you had a problem with my furniture.”

“Not really,” he replied. “But I have a message for you from Shovelhead, and he said he didn’t think he should call there himself.”

“I understand,” she replied neutrally.

“He said to drop by his office after your office hours. It’ll be past his hours but he’ll still probably be busy.”

“I see no problem with that,” she replied, trying to sound like she was talking about furniture. “I take it everything else is on schedule?”

“Except for the drapes, and you know about that.”

“Thank you, Mr. Evachevski,” she replied. “I’m glad to know I can trust you.”

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