Les Femmes Noires One-Shot Contest
Title: The Good Mother
Pen Name: Legna989
Disclaimer: All publicly recognizable characters, settings, etc. are the property of their respective owners. The original characters and plot are the property of the author. The author is in no way associated with the owners, creators or producers of any media franchise. No copyright infringement is intended.
"It's slow, even for a Tuesday."
Shelly Cope's attention was drawn away from the romance novel she was reading by the young resident's statement. She smiled slightly to herself as she waited for the response she knew would come.
"Don't say that! You'll jinx us," another of the ER residents admonished.
Mrs. Cope had worked as an admit desk clerk at County Hospital for going on fifteen years, and had heard nearly this exact exchange more times than she could count. Just as she was returning her attention to her book, and almost as if it had been scripted out of a television hospital drama, the sliding doors opened and a frantic woman came bursting into the admit area carrying a baby boy in her arms.
"Oh, Shelly, it's Daniel! He's vomiting again, and he's had diarrhea all day. He's so lethargic…I didn't think I should wait until tomorrow to get him to a doctor."
"That's fine, Mrs. Evenson. Better safe than sorry, right?" Mrs. Cope efficiently pulled up Daniel Evenson's record from the hospital computer system and began preparing the required admission forms. "Same address and insurance information?"
"Yes. It almost seems like those forms should print themselves by now, doesn't it?"
Mrs. Cope made a non-committal 'mmmm' sound as she finished printing the forms, thinking to herself that she had seen an awful lot of ten-month-old Daniel Evenson and his mother, Esme. Most of the hospital staff had. Even though the staff dealt with tragedy every day, it seemed especially unfair for such a sweet baby to have been so sick, so often. And one with such a devoted and kind mother, at that.
"Esme? Is Daniel sick again?" Alice Brandon, one of the ER nurses, asked.
"Yes! I'm truly at my wit's end, Alice. He seems to be doing fine for a while, and then out of nowhere, it starts up again: the diarrhea, the vomiting, the lethargy. He's just so sweet and playful when he's well, and it's so hard to see him like this!" Esme's voice had started to take on a note of hysteria as tears sprang to her eyes.
"I know, Esme. Why don't we get him back to the exam area and see about getting him well again, okay?" Alice took the chart from Mrs. Cope and led Esme and Daniel into a curtained area down the hall from the admit desk.
"Has Carlisle been paged yet?" Esme asked as Alice was recording Daniel's vital stats.
"I'm not sure Dr. Cullen is on tonight, Esme."
"What? But he's the one who's been treating Daniel! He knows the history; he knows what we've already tried. Maybe I need to call him at home."
"Esme, I know you're upset. But why don't we take it one step at a time, okay? Dr. Kishk is the attending on duty in the ER tonight; he's seen Daniel before. Who knows if he'll even have to be admitted to Peds?"
Esme took a deep breath and tried to calm herself. "Of course, I know you're right, Alice. It's just…this whole situation. It's just frustrating not knowing what's wrong with Daniel or how to fix it."
A moment later, Dr. Amun Kishk arrived at Daniel's bedside. "Good evening, Mrs. Evenson. Talk to me about what's going on with Daniel this time."
Esme didn't really care for Dr. Kishk. He was a competent enough physician, she supposed, but he was always so business-like, almost cold. He wasn't compassionate like Dr. Cullen. Still, she'd been in this situation with Daniel enough to know that the more information she could provide, the better the staff would be able to assess and treat him.
"He'd been doing fine for the past three weeks, since he was discharged the last time. Active, playful, crawling around like crazy. His appetite has been good, and his color has been so much better. He's even outgrown some of his clothes, which I didn't think I'd be able to say, with all the weight he'd lost." Esme shot a rueful smile. "And then this morning, I noticed that he had a bit of a loose stool. I tried not to get too worried about it—I know it happens—but it just got progressively worse through the day. And then about two hours ago, he started vomiting. He went from active and playful this morning to sick and lethargic tonight, and I just didn't feel like I should wait to bring him in."
"You did the right thing, Mrs. Evenson. Right now, our biggest concern is fluid loss. We need to get him started on an IV, and I want to order a blood gas and check electrolytes. Make sure the lab puts a rush on that, Ms. Brandon, and please call for a Peds consult." Dr. Kishk quickly wrote the orders in Daniel's chart and handed it back to Alice.
"Will Daniel need to be admitted?" Esme asked.
"I think that's likely, but I'd like to wait for the labs to come back and discuss the situation with Pediatrics before we make any decisions," Dr. Kishk replied before walking away.
Esme sighed and stroked her son's face as Alice drew blood and placed the IV in his tiny hand. They were lucky that three weeks of relatively good health had left his peripheral arteries in good shape, and a cut-down wouldn't be needed. Yet.
Alice sent Daniel's blood to the lab for the ordered tests and called up to the Pediatric Unit.
"Peds, this is Angela."
"Angela, it's Alice down in ER. Daniel Evenson is back again. Can you send down the resident on call?"
"Oh, no. Same thing?"
"Yeah. I feel so bad for Esme; I don't know how she does it."
"I know. Her strength is amazing, being a single mother and all." After a beat, Angela continued, "Listen, it's Dr. Hale on call tonight. I'll send her right down."
Rosalie Hale was the newest pediatric resident at County. She had been working at the hospital when Daniel Evenson had last been admitted, but she hadn't been directly involved in his care. Even in her short time at the hospital, however, Rosalie knew that Daniel was a "frequent flier." She'd heard several of the nurses discussing Daniel and his mother, Esme. Most of what she'd heard was both sympathetic and complimentary: Daniel's repeated illnesses were sad and confounding; Esme was virtually a saint who devoted her entire life to caring for her chronically ill son.
There was the occasional whisper questioning the propriety of Esme's seemingly close relationship with the doctor primarily responsible for Daniel's care, Carlisle Cullen, but no one had ever witnessed anything untoward. Rosalie knew that Dr. Cullen was extraordinarily compassionate, even for a pediatrician, and she wondered sometimes how he did it. Working Peds was notoriously challenging. A doctor had to be careful not to get too attached, but still had to remain approachable and unintimidating. It was something Rosalie was still trying to master.
Dr. Hale's first stop in the ER was at the admit desk, where she found Dr. Kishk.
"Dr. Hale. You must be here for my consult."
"In fact, I am, Dr. Kishk. What've we got?"
"Daniel Evenson, ten months. His mother brought him to the ER reporting diarrhea lasting all day, vomiting for the past two hours, and general lethargy. He has a low-grade fever and his heart rate is slightly elevated. He has been admitted to this hospital three times previously for similar complaints. I've ordered a blood gas and electrolyte levels and started an IV to counteract dehydration."
"Are the labs back?" Rosalie inquired.
"Just got them." Dr. Kishk handed Daniel's chart to Rosalie.
Daniel's electrolyte levels were badly awry. "Sodium 170. Potassium 2.4. Carbon dioxide 55? BUN 26…that's to be expected, if he's dehydrated. The only thing normal is his chloride, at 102. We're going to need to admit him."
"That's what I anticipated."
"Well, let's take a look at this little boy." Dr. Hale let Dr. Kishk lead the way to Curtain Area 3, where they found Esme Evenson quietly singing a lullaby to Daniel, who seemed to be dozing peacefully.
Dr. Kishk made the introductions. "Mrs. Evenson, this is Dr. Hale, the pediatric resident on call tonight."
"Dr. Hale. I don't think I've ever seen you before."
"I believe this is the first time we've met. I'm sorry it has to be under these circumstances, Mrs. Evenson." Rosalie could feel the weight of Esme's appraisal; she knew in that moment that Esme was a force to be reckoned with, and she would need to be handled carefully so that Daniel's care was not compromised.
"I'm sorry, too. Do we know what's wrong yet?"
"Daniel's labs show elevated sodium and decreased potassium levels. We need to admit him so that we can continue to administer IV fluids and monitor his electrolytes." Rosalie braced herself for Esme's reaction, and was mildly surprised when Esme simply nodded and asked how long the transfer would take.
After reassuring her that they would try to get Daniel in a pediatric bed as quickly as they could, Rosalie turned to leave, but stopped when Esme called out to her.
"I hope you don't take offense at this. It's just that I don't know you. Daniel doesn't know you. Car- Dr. Cullen has been very involved with Daniel's care since his first admission, and I would really feel a lot more comfortable if he was at least made aware that Daniel had been admitted again."
Rosalie bristled at the unspoken suggestion that she didn't know what she was doing, but worked hard to control her reply. "I understand, Mrs. Evenson, and continuity of care is important. But this is Dr. Cullen's day off, and he is not on call tonight. I'd really hate to disturb him, especially when he'll be in at 6:00 a.m. tomorrow for his next shift. Daniel is resting comfortably right now, so why don't we get him settled in the pediatric unit and take it from there?"
Esme's eyes narrowed slightly. She understood the need for a new resident to prove herself, but she knew Dr. Cullen would want to know about Daniel. Still, she said nothing, merely nodding at Dr. Hale and thinking to herself that she could always call Carlisle's cell phone, whether Dr. Hale thought it was a good idea or not.
Forty minutes later, Daniel was situated in a crib in the pediatric unit. Esme made herself as comfortable as she could on the recliner near Daniel's crib. She knew that the nurses would be in periodically to check on Daniel, and she didn't want to be in their way, but she also felt it was important to be as close to Daniel as possible. She didn't want him to be scared when he woke up in the strange environment, even if he'd been here so much that it could hardly be considered strange anymore.
As she gazed at her sleeping son and listened to the steady whirr-click of the IV, she turned her cell phone over in her hand and once again contemplated calling Carlisle. Seeing that it was after midnight, and remembering that Dr. Hale had said Carlisle would be in at 6:00 a.m., Esme decided not to bother him. She would see him soon enough.
Carlisle Cullen had been a pediatric attending at County for four years, and had been a resident there for four years before that. He was a very well-respected physician, and was known for his dedication to his patients. He wasn't married, and had no children of his own, although there was no shortage of nurses and fellow doctors interested in changing his marital status. It wasn't that Carlisle was commitment-phobic or didn't want children. He just felt called to medicine so profoundly that nothing had been able to divert his attention from it.
Carlisle had gotten close to many patients and their parents over the course of his career, but none so much as Daniel Evenson and his mother. Carlisle had been on call the first time Esme brought her son to County. His symptoms had indicated gastroenteritis, but in an infant, even something so basic can be dangerous. So Carlisle had admitted Daniel to the pediatric unit for observation and fluids. Daniel's stay that first time had been brief—just two days—but the sweet boy and his engaging mother had made an impression on Carlisle.
Carlisle had learned that Esme was a war widow, her husband, Charles, having been killed mere months into his second tour in Afghanistan. She had moved to Chicago just before Daniel was born, after finding a teaching position at an elementary school in the city. Carlisle found himself impressed with Esme's strength in the face of her grief and the challenges of new motherhood.
His admiration for her only grew each time Daniel was admitted to the hospital. Esme was utterly devoted to her son. She rarely left his bedside; Carlisle and other staff members often had to remind her to eat, telling her that she would be no good to Daniel if she got sick, too. She had charmed most of the staff in the pediatric unit with her uncanny ability to remember names and faces. She did research on possible causes of Daniel's symptoms and became so familiar with medical terminology that Carlisle thought she might have made a pretty good doctor.
And if Carlisle was being completely honest, he found Esme Evenson to be quite attractive. Carlisle would never compromise his career or his integrity—or patient care—by engaging in a romantic relationship with a patient's parent, but he had imagined what might happen after they got a handle on Daniel's illness and he was no longer a regular patient of Carlisle's.
Carlisle shook those thoughts from his head as he looked over Daniel's latest lab work. His sodium levels had decreased, but were still elevated. His potassium was still too low. And his CO2 levels were still abnormally high.
"Recommendations, Dr. Hale?"
"I think we need to run an EKG. I'd also recommend increasing the sugar in his IV and adding potassium."
"That sounds about right. Good work last night, Dr. Hale. I know this was your first time treating Daniel, but we've obviously seen him in here a few times. We're still a little stumped about what might be going on with him."
"Thank you, Dr. Cullen. Looking through his chart, I saw that most of the expected diagnoses had been previously ruled out: viral gastroenteritis, lactose intolerance, bowel inflammation, parasites. Have you considered Bartter Syndrome?"
"Well, his low potassium certainly points to that as a possibility, but it wouldn't explain the high sodium. Still, it seems like we've tried just about everything else at this point. Let's go ahead and dip a urine, too, and see what that says."
Carlisle had been dismayed to see Daniel's name on the board when he arrived for his shift earlier that morning. Daniel had shown marked improvement during his two-week hospital stay the previous month, and when Esme had brought him by the hospital to say hello to everyone just a week ago, he had seemed like a completely different little boy. Carlisle had only gotten to spend about five minutes with him and Esme before he got called away to attend to another patient, but in that time, Daniel laughed and smiled more than Carlisle had ever seen. Esme had been radiant.
Looking at her now, he could see the toll Daniel's repeated illnesses were having on her. She looked exhausted—but somehow at home—in the reclining chair in his little room.
"Do you have any questions, Mrs. Evenson?" Esme had asked Carlisle to call her by her first name on more than one occasion, but he felt it was important to maintain a higher level of professionalism while rounding with the residents.
"Well, I understand that you're going to test his urine, but what is Bartter Syndrome?"
"Patients with Bartter Syndrome are unable to reabsorb potassium in the kidneys, and the kidneys end up taking too much potassium from the body. It's known as potassium wasting. Because Daniel's potassium levels are so low, it's a possibility. We're looking for elevated potassium in his urine to see if that's the case. Do you understand?"
"Yes. And the EKG is because of the low potassium, too, isn't it?"
"Yes. Low potassium levels can cause arrhythmia, so we just want to make sure we're giving Daniel the best care possible."
"Thank you, Dr. Cullen."
"It's our pleasure to treat Daniel, Mrs. Evenson. I'll be back later, after the results of the latest lab work are in. We'll talk more then."
Daniel Evenson's urine test showed no elevated potassium, and Bartter Syndrome had been ruled out. It had been a long shot, anyway, Rosalie thought to herself as she lay in bed later that night. Her thirty-six-hour shift was finally over, and she should have been exhausted, but her mind would not turn off. She couldn't stop thinking about Daniel Evenson and his mysterious symptoms.
His sodium levels had continued to decrease, however slowly, throughout the day, and his potassium went up after they added it to his IV. He was still unable to take food orally, however, so he was receiving nutrition intravenously. There just didn't seem to be an explanation for his illnesses. Four hospitalizations in ten months, with the likely diagnoses all ruled out. Rosalie considered the possibility of a pancreatic tumor, even while her brain tickled at something on which she couldn't quite put her finger. Maybe sleeping on it would be a good idea, she thought as she finally drifted off.
When Rosalie reported for her next shift, she was pleased to see that Daniel Evenson's condition had improved. His electrolytes were almost back to normal, and cereal and formula had been reintroduced the previous day, Rosalie's day off, in small quantities. Dr. Cullen, however, looked like hell.
"Have you rested at all while you've been here, even in the on-call room?" Rosalie asked.
"You know how it is, Dr. Hale," Carlisle hedged. He was reluctant to admit that he had spent most of his down time with Esme and Daniel.
"I couldn't stop thinking about Daniel's case, either," Rosalie said.
Carlisle gave her a small smile. "He does tend to get under your skin, doesn't he? And this is my fourth time treating him, so you can imagine my frustration at this point."
"I can. Still, he's doing a lot better today, and if he manages to hold down his food today, we can probably look to release him tomorrow. Why don't you head on home? You were supposed to be off two hours ago."
"I think I'll take your suggestion. Just page me if anything changes."
After bidding Dr. Cullen farewell, Rosalie made her way to Daniel's room.
"Looks like he's doing a lot better," she said as she slipped through the door. Esme was rocking Daniel, who was taking a bottle and was drifting off to sleep.
"Much better," Esme said quietly.
"Dr. Cullen said that we may be able to discharge Daniel tomorrow, barring any complications."
Esme looked up sharply. "Tomorrow? Don't you think that's a bit soon?"
"Don't you want to be able to take Daniel home?"
"Well, of course. But I don't want to take him home only to have to turn around and bring him right back. I want him well!"
Daniel began fussing at Esme's raised voice and she gently shushed him.
"Of course, Mrs. Evenson. We wouldn't discharge Daniel if we thought he hadn't improved enough. Let's just see what the day brings, okay?"
"I trust you all. I know that you will do what's right for Daniel."
Rosalie nodded and excused herself. The tickling in her brain was growing more persistent, but she still couldn't quite pinpoint what was bothering her.
Six hours later, Rosalie was reluctantly paging Dr. Cullen after Daniel's diarrhea started again. Carlisle arrived no more than ten minutes after the call.
"I'm sorry to bother you, Dr. Cullen, but you said to page if there were any changes."
"It's fine, Dr. Hale. I'm glad you did. Have you ordered the blood work?"
"Yes, but we're still waiting on the results." What Rosalie didn't tell him was that she had ordered that a stool sample be tested as well. Normally, there would be no point to testing a patient's stool, as doing so would simply reveal what the patient had eaten. And in a child with diarrhea, the stool sample would naturally have a higher concentration of sodium.
But that tickling at Rosalie's brain had finally taken some shape over the course of her shift. She had gone back through Daniel's chart, not just from this stay but from all of his hospitalizations. There seemed to be a pattern—subtle, but there. It wasn't something she wanted to believe, and she knew she needed to have as many hard facts as possible, so she calculated Daniel's known sodium intake from his IV, and from the formula and cereal he'd been given. The sodium in his stool sample should be equal to his intake. If it was, then the pattern Rosalie had seen was probably irrelevant. But if it wasn't….
She was concerned about how Dr. Cullen would react when he learned she had ordered such an unusual test. She was both hoping and not hoping that the results would show that it had been worth it. She didn't want to incur her attending's ire, but this was a situation in which she really didn't want to be right.
While Dr. Cullen went to talk to Mrs. Evenson, Rosalie stalked the lab, wanting to get the results as soon as they were ready. She was not prepared for what she saw, even if she had expected as much.
"Are you sure this is right?" she asked the lab tech.
"Daniel Evenson. Yep."
Rosalie's stomach dropped and her heart started pounding as she contemplated showing Dr. Cullen the test results. She was no longer worried that he would be upset that she had ordered the test. She just didn't know how he was going to take this new information.
Rosalie also knew that the situation would have to be handled very delicately. This was only one test, and more would need to be done before any real action could be taken. Daniel's well-being was paramount.
Rosalie was resolved to wait for Dr. Cullen to come out of Daniel's room before she showed him the test results, but she was spared having to do that when she found him by the nurses' station upon her return from the lab. She took a deep breath and steeled herself for the conversation to come.
"Dr. Cullen, I'd like to discuss the results of Daniel Evenson's latest lab tests with you."
She handed over the paperwork and watched confusion mar his handsome face as he reviewed them.
"You ordered a stool sample?"
"May I ask why?"
"We've ruled out so many possible diagnoses for Daniel's symptoms. It doesn't make sense that he is still having these problems. And I noticed that his symptoms resumed after food was reintroduced, yet we'd already ruled out lactose intolerance, so I knew it couldn't be that. I guess I just wondered if there was something in his diet that was causing the symptoms."
"I calculated what Daniel's sodium intake should have been, based on the IV, cereal and formula he's been given. The sodium in his stool is more than twenty times higher."
"What are you not saying, Dr. Hale?"
"I think we need to test the formula and cereal."
Carlisle clenched his jaw, not wanting to let his mind go there. But whether he wanted to believe it or not, Dr. Hale could be onto something.
"We should probably also move Daniel to PICU," he said.
"Mrs. Evenson won't like that. Visitation is much more restricted."
As expected, Esme was very upset about Daniel's move to the pediatric intensive care unit. "But why this change now? He'd been improving!"
"Esme, his sodium levels are back up, and his potassium is down again, to dangerous levels. We're just trying to make sure we're prepared for any complications."
"What's his sodium? It had gone down! The last notation in his chart showed that it had gone down!"
Carlisle closed his eyes briefly at the questioning look Dr. Hale gave him at Esme's statement. It was not standard protocol for the parents of patients to have access to charts. But Esme was so eager to understand her son's condition, to figure out what she could do to help, that the staff hadn't seen the harm in letting her look at Daniel's chart. She was intelligent enough to understand what she was reading, and in pediatrics, where the patients couldn't really convey symptoms, it was helpful to have parents who could give the right kind of information. At this moment, however, Carlisle feared that the staff's indulgences with Esme were going to prove to have been a mistake.
"His sodium is at 168-"
"But that's not even as high as it was when he was admitted, and you didn't put him in PICU then! I knew I should have called you that night, instead of just relying on Dr. Hale to do the right thing."
Carlisle saw Dr. Hale's shoulder stiffen a bit, and he spoke before she could. "Dr. Hale made the right call that night. Daniel showed signs of improvement after his admission, as you know, Esme. The decision to move him to PICU now is a reflection of his once-again deteriorating condition, and the fact that we lost his peripheral artery for IV access and have had to place a central line. We need to get a handle on this, and the best way to do that is to move him to PICU."
"I just don't understand this! I won't be able to stay with him in PICU! That can't be good for him. I'm all he has!"
"Esme, you will be able to visit with Daniel for five minutes every hour. He'll still know you're here for him."
"Five minutes? That's so unfair! He's used to me being there for him all the time!" Esme was hysterical now, openly sobbing.
"I know. But Daniel will be getting the best care possible in PICU, Esme. He won't be alone; he'll be monitored constantly."
Esme stood as she became more agitated, and Daniel began fussing quietly. "Don't you see? It's so unfair! He'll be so scared! All the procedures, all the things they'll need to do to him. He needs me so much! What will it do to him to be in there without me? What will it do to me?"
"Esme, I know you're scared and worried for Daniel, but we really feel that this is the best move for Daniel's care. You want Daniel to get better, don't you?" Carlisle's natural instinct was to reach out and touch Esme's shoulder, but he couldn't help but worry that his personal feelings about Esme had clouded his judgment, and he settled for handing her a tissue from the box on the table next to the recliner.
"Of course I do! But I don't see how separating me from him is going to make him better! It will only make things worse." Esme absently dabbed at her teary eyes.
"I understand your concerns, Esme, I do. But I need you to trust me to make the right medical decisions for Daniel."
Esme wasn't happy about the move to PICU, but calmed down enough to acquiesce to Carlisle's decision. The transfer was completed within half an hour.
The PICU nurses knew Esme—Daniel had spent some time there during one of his previous stays—but they had not developed the same kind of personal relationship with her that some of the other staff had. There were also strict policies in place with regard to treatment and monitoring, so Carlisle felt comfortable taking some time away from the unit to attend the meeting called by the head of pediatrics.
The tests on Daniel's cereal and formula had come back, both showing markedly higher sodium levels than they should have. There were only two possible explanations for the discrepancy. A mistake or defect at the manufacturing level seemed unlikely, given that the sodium was abnormally high in two different products from two different manufacturers. That left one possibility.
Carlisle had spoken with Maggie Ryan, the head of pediatrics, prior to telling Esme about Daniel's move to PICU. Carlisle knew what Dr. Hale's suspicions were, and he was beginning to share them, loathe as he was to believe it. He knew that things would need to be handled carefully, for both Daniel's sake and the hospital's.
"Okay, we're all here to discuss Daniel Evenson's care. I've asked Charlotte Chambers from Risk Management and Jason Jenks, the hospital's legal counsel, to sit in on this meeting. Anything said in this room needs to stay in this room, for now. Are we all on the same page?" At the nods from the staff in attendance, Dr. Ryan continued. "Drs. Hale and Cullen have been primarily responsible for Daniel's care during his current admission. Some of the tests they've run have raised some questions, and we need to make sure we have all of our information straight. Dr. Cullen?"
Dr. Cullen briefly outlined the tests that had been run on Daniel's stool and the formula and cereal. "There's no delicate way to ask this, and I'm not trying to point any fingers here, but it's important that we have our facts straight so I need everyone to be honest. Who has been mixing Daniel's formula and cereal for his feedings while he's been here?"
The pediatric nurses and assistants shifted uncomfortably and exchanged looks.
"Most of the time, one of the nurses or NAs has done it, but sometimes if we're busy, Mrs. Evenson helps out. She knows the proportions," answered Angela Cheney.
"So, Mrs. Evenson knows where the formula and cereal are kept, and she mixes it herself to give to Daniel?" asked Dr. Ryan.
"Sometimes. You know how it is. We have so many patients to attend to, and Esm- Mrs. Evenson is so dedicated and willing to help. I think it makes her feel more useful," Tia Sands, another pediatric nurse, replied.
"Of course. And were those instances charted, when Mrs. Evenson mixed the formula or cereal herself?"
"Well…we always note specifically when one of us mixes it. So any occasion where there's nothing about mixing it prior to a feeding, that means Mrs. Evenson did it."
"We'll need to talk about policies and review charting procedures at a later date," stated Charlotte Chambers, "but our priority at the moment is dealing with this situation with Daniel Evenson."
"Agreed. Dr. Cullen, is there a way to tell from Daniel's chart whether worsening of his symptoms corresponds to specific feedings?" asked Dr. Ryan.
"Not always, which is probably why it wasn't noted earlier. Dr. Hale, what made you think to check his stool? Did you see a pattern?"
Rosalie wanted to word her answer carefully. She didn't want to imply that Dr. Cullen had missed anything. "Only a very subtle one. I wasn't even sure it was a pattern, to be honest. There didn't really seem to be any rhyme or reason to Daniel's symptoms. He did well both at home and here, and he would also relapse both at home and here in the hospital. And he would also seem to do fine for a little while after food was reintroduced. So I don't think there was anything glaringly obvious. It was more a hunch than anything, and maybe a little desperation, since there didn't seem to be any other reason for his symptoms."
"Well, looking here, I note that on his first day back on food during this visit, a nurse or nursing assistant mixed the formula each time. And Daniel was doing fine. His symptoms didn't start up again until the second day, at about 2:00 in the afternoon, and Mrs. Evenson mixed his bottle that morning," noted Dr. Ryan.
"After I mentioned his possible discharge," Rosalie murmured.
"What was that, Dr. Hale?" Dr. Ryan asked.
"It's just that I had checked in on Daniel earlier that morning, and discussed his improvement with Mrs. Evenson. I mentioned that we might be able to discharge Daniel the next day, which seemed to upset Mrs. Evenson a little bit. She was worried it was too soon," Rosalie explained.
Carlisle grimly shook his head. "She was also very upset about Daniel's move to PICU."
"Well, he's there now, and being very carefully monitored. So what are our next steps?" Dr. Ryan asked Charlotte Chambers.
"We need to contact social services, and probably the police. Even the most minute detail of Daniel Evenson's care in PICU needs to be thoroughly documented, including observations of his mother. At no point should she be allowed to feed him."
"He's getting nutrition through his IV right now, and if we get to the point of reintroducing food, I'll make sure the PICU nurses know that they are to mix all formula and feed Daniel themselves," Dr. Cullen assured her.
The meeting was adjourned and Carlisle dejectedly headed back to PICU to check on Daniel. How was he supposed to act normally around Esme? He chastised himself for getting too emotionally involved with a patient and his mother, and scoured his mind for every detail he might have missed. He hated to think that he'd been fooled. But then, he wasn't the only one.
As he gazed at the tiny boy, colorless and laden with tubes, Carlisle wondered how any parent could want to harm him, how anyone could want to harm him. He wondered what would happen to this child, with his father dead and his mother…Carlisle still had a hard time believing it.
Daniel's condition continued to improve little by little throughout the day, and it became more and more difficult to justify to Esme why she couldn't spend more time with him. Two detectives from the Crimes Against Children Unit had been by to interview staff and get Daniel's medical records, but they had decided not to talk to Esme just yet. Detective Whitlock had explained to Carlisle that building a case like this was like building a house of cards: one wrong move, and it would all come crashing down. They didn't want to talk to Esme until they had a solid foundation established for a case of Munchausen's by proxy.
That was the clinical, and legal, term for it. Munchausen's syndrome by proxy. Parents—usually mothers—who harm their children in order to get attention for themselves from medical personnel. Esme fit all the classic signs. She ingratiated herself with staff, developed personal relationships with them, became well-versed in medical jargon, and sacrificed all of her time and her own well-being to care for her very ill son. Carlisle was beyond frustrated that he hadn't seen it.
The police were waiting, but a social worker had spoken to Esme. Bella Swan was careful not to imply that there was an investigation, but she couldn't avoid speaking to Esme. It was part of her job. The department had to tread carefully. Daniel was safe for the time being, closely monitored in PICU. However, as his mother, Esme could still decide to take him from the hospital against medical advice, and police intervention would be required to stop her. No one wanted a big scene in the middle of the PICU, so Bella talked to Esme about services available to single parents and then asked about Daniel's illnesses.
Esme wasn't an idiot. She knew something was going on. She knew if she could just talk to Dr. Cullen alone, she could get everything cleared up. But it was as if Dr. Hale was glued to his side now. She knew there was a reason she didn't like Dr. Hale. It seemed as if Dr. Hale was jealous of the attention Dr. Cullen paid to Esme, and she had done something to turn Dr. Cullen against her. She just knew it. She hoped that during her next visit with Daniel, she could get Dr. Cullen away from Dr. Hale.
The nurses' station in the PICU was situated centrally to all the patient rooms, like the hub of a wheel, with the rooms as spokes. The rooms themselves were walled with glass, so the nurses could monitor the patients constantly without having to be in the room.
Carlisle was standing at the nurses' station talking to Detective McCarty, who had come back to talk to Dr. Cullen about what he knew concerning Esme's background.
"So, your understanding is that Mrs. Evenson is a widow?" Detective McCarty asked.
"Yes. Her husband was killed in Afghanistan before Daniel was even born," Carlisle replied.
Detective McCarty shook his head. "Her husband was in the military; that much is true. But he was dishonorably discharged about two years ago. He still lives in Cleveland."
"But why…he hasn't been involved in Daniel's life at all."
"Far as I can tell, he doesn't even know Daniel exists. The guy's a drunk who didn't even care enough to look for his wife after she took off."
"Why would she tell everyone that he died?" Carlisle asked.
Detective McCarty shrugged. "Attention, maybe? Seems to be her pattern."
Esme breathed a sigh of relief as she entered the PICU. Dr. Cullen was there, and Dr. Hale was nowhere in sight. She noticed the man speaking with Dr. Cullen, dressed in a shirt and tie, and assumed he was another doctor she hadn't met. She didn't see the badge clipped to his belt.
She checked in with Kate, the charge nurse, who noted her arrival on Daniel's chart and told her to go on in. Detective McCarty noted her arrival, too, and shifted slightly closer to Daniel's room as he watched her go in. Carlisle noticed the movement—Detective McCarty was a big guy—and turned his head to see Esme enter Daniel's room. He watched her place a gentle kiss to Daniel's forehead and couldn't stop the smile when he saw Daniel's face light up. Maybe they were wrong.
But then he noticed the odd contortion of Esme's elbow as she pulled something out of her pocket. He saw her shift so her body was partly obscuring Daniel's. Carlisle took four long strides to Daniel's room, Detective McCarty on his heels. In a flash, Detective McCarty had his arms wrapped around Esme. She thrashed against him, and something dropped to the floor.
"What's in it?" Detective McCarty asked.
"Looks like nothing. Just air," Carlisle replied. At Detective McCarty's puzzled look, Carlisle continued, "Introducing air into his central line could cause an embolism, stopping his heart."
"I found it on his bed! Someone here has been doing something to him, I just know it! I'm sure it was that Dr. Hale; she doesn't like me!"
Carlisle could only shake his head.
"Let me go! Why would I do something like this? I love Daniel! He's all I have, and I'm all he has! You don't understand how much he needs me! Carlisle, you can't believe this!" Esme cried.
"I don't know what to believe right now, Mrs. Evenson," Carlisle solemnly replied.
Esme stopped fighting Detective McCarty and squared her shoulders as he loosened his hold on her.
"That's fine. This is all just a misunderstanding. We'll get it straightened out, you'll see." She touched her hand briefly to Daniel's. "Be a good boy for Dr. Cullen. Mommy will be back soon."
Detective McCarty was starting to lead her out of the room when she stopped and turned back to Carlisle.
"See? I'm a good mother."
Many thanks to ElleCC for her excellent beta work and enthusiastic support. This is much better now than it was before she worked her magic.
Thanks also to LaViePastiche for pre-reading and lending encouragement.