Part 5 (1/2)
”Yes, if you feed them, they grow. Right, handsome?” Jill spoke to Rahul, and he broke into a smile, with wet lips, which showed he wasn't dehydrated. To double-check, she pinched him gently on the arm, and his skin didn't tent. ”What a tough guy! No crying, huh?”
”He's the third. They learn.”
Jill smiled, stroking Rahul's soft cheek, noting his color. His Indian ancestry gave his skin a glow, but she'd trained at D.C. Children's, where she'd seen kids of all races, and she thought he was febrile, feverish. ”He look flushed to you, Dr. Mom?”
”He always does when he gets an ear infection. So, do you have a wedding dress yet?”
”I'm thinking a lab coat. It's white, right?”
Padma laughed. ”Come on, tell me everything. It's fun to talk girly stuff. I love being a boy mom, but I wish for something with ruffles at times.”
”Well, I do have a suit, a nice one.” Jill palpated the axillary lymph nodes under Rahul's armpits, which were also swollen. ”Megan's addicted to Say Yes to the Dress, so I'm failing her as a mother.”
”I know that feeling. It comes with the territory.”
”Ha!” Jill peeked inside Rahul's diaper, which was clean and dry. ”They'll grow up and realize how lucky they were, but by then, we'll be dead.”
Padma laughed.
Jill's last stop was to examine Rahul's skin, and she noticed a tiny patch on his right arm, which reminded her of something about his older brother, also a patient. ”Roy has hay fever. Do you or Dave?”
”Yes, I do. Why?”
”Look at this.” Jill showed her the patch. ”This is eczema.”
”Really?” Padma peered at it, frowning. ”I thought it was a rash, or maybe poison ivy. He was playing in the gra.s.s yesterday while I weeded.”
”It's not uncommon in babies, and it's nothing to worry about. But we call asthma, allergies, and eczema, the allergic triad. It runs in families, and several of them can be in the same child.”
”They do, I know, in my family.”
”Let me see the rest of you, Rahul.” Jill examined the skin on his chest, legs, neck, and back, with its tiny scapula, like the nubs of angel wings. There were no other eczema patches. ”How's he eating?”
”Not great, but not terrible.”
”Drinking?”
”Okay.”
”Sleeping? You said he tugs at his ear?”
”Yes, off and on, at night.”
”Poor little guy.” Jill looked up and met Padma's eye. ”I think you're right, it's another ear infection, but he gets a lot of ear infections for a baby who's not in day care. On the other hand, he has older brothers, so I bet he gets all the colds they bring home from school.” Padma's eyebrows sloped down unhappily. ”Do you think he should get tubes? My brother does, and they helped my nephew.”
”No, I wouldn't do that for Rahul. We used to do that more often, because of language impairment, but he isn't showing any delays. You can dress him, now.” Jill went to the computer on the desk, typed her pa.s.sword into Epic, opened Rahul's file, and typed in her notes. Pembey Family Practice had EMR, or electronic medical records, but Jill always waited until after the exam to record her findings. She liked to look the mom in the eye and stand in front of a child, not a keyboard.
”So no tubes?” Padma asked.
”Not yet. Let me check one last thing in his file.” Jill navigated to Rahul's weight chart, with its line climbing up a hill, until six months ago. He'd started life in the thirtieth percentile, but now was down to the fifth, which meant he fell off his curve. That wasn't good, either.
”So, amoxicillin?”
”Yes, since it's been over a month since the last time he'd used it, and Tylenol, too.” Jill closed out the file, leaving the screen waiting for the pa.s.sword of the next doctor. She'd coded it as a URI for insurance purposes, but she wasn't 100 percent sure why it kept happening. The saying in medicine was, if you hear hoofbeats, don't go hunting for zebra, but Jill knew better. Zebras existed, and pediatrics was full of them. She stood up. ”Let's see him again on Wednesday. I know you're busy, but I want to keep an eye on him.”
”Okay.”
”Also, before you leave, I'd like to take some blood.” Jill didn't elaborate because she wasn't about to alarm Padma. There was a chance that Rahul had an autoimmune problem, leukemia, or lymphoma, but they were only remote possibilities. ”The lab's just down the hall. It won't take long.”
”Blood?” Padma's dark eyes flared. ”For an ear infection?”
”Yes, I want to know why he keeps getting them, and a blood test will give me a complete picture of what's going on in his system and see what type of infection his body is fighting.” Jill didn't add that the blood test would tell her how many and what type of white blood cells Rahul's body was producing, whether lymphocytes, neutrophils, or monocytes, and that would eliminate the more serious diagnoses. ”You only have to take him down the hall, and I promise Selena will make it easy.”
”Okay, if you think it's really necessary.” Padma pressed a strand of dark hair into her short ponytail.
”I do, and I'll call you when I get the results, probably on Tuesday. Please let me know if anything changes.” Jill printed out a script for amoxicillin, signed it, and handed it to Padma. ”Here we go.”
”Thanks.” Padma picked up Rahul's little jeans, and Jill placed a rea.s.suring hand on her shoulder.
”I mean it, don't hesitate to call me.”
”Will do. Thanks again.” Padma smiled, and Jill gave her a hug.
”Love to the boys and Dave. Rahul, bye-bye.” Jill caressed the baby on the cheek and left the examining room, checking her watch on the fly. Pembey Family Practice had office hours until one o'clock on Sat.u.r.days, and it was 1:15, so she wasn't as behind as usual. She needed to spend time with the patients, but it put her in constant conflict with their office manager, Sheryl Ewing. Jill hoped to leave today without seeing Sheryl because she didn't need the lecture, with the memorial service ahead of her.
She bustled to her office, thinking of William, and anger flickered in her chest, an ember that didn't need fanning. She felt hypocritical going to his memorial service when, in her darker moments, she had actually wished him dead. And if she were really honest, she wouldn't be surprised if it turned out that someone had murdered him.
Because in her very darkest moments, she would have done it herself.
Chapter Eight.
Jill drove down Route 202, heading east toward Philly, with a somber Megan in the pa.s.senger seat, her face turned to the window. Even her phone was quiet, and Jill wondered if she had silenced it or turned it off. Rain pounded against the winds.h.i.+eld, and they pa.s.sed a strip mall that used to have a huge Circuit City, which was now vacant. The only sound was the rhythmic beating of the wipers and the low rumble of the road.
”You look nice, honey,” Jill said, looking over. Megan looked grown up in a simple black dress she wore for choir concerts, with low-heeled black shoes. Her hair was still wet from the shower and gathered in a black velvet scrunchy.
”Thanks.” Megan turned to her, with a brief smile, but the strain showed on her face. ”Is this service gonna be weird?”
”A little, but we'll get through it.”
”Will it have an open casket like Grandma's?”
”No.” Jill felt a pang, thinking of her mother's wake, in the funeral home. ”This isn't a Ma.s.s, it's a memorial service, in a church. An historic church.”
”William didn't go to church.”
”Sometimes they hold services in church, even if the person didn't go there.”