He rolled his motorcycle to a stop next to the brightly lit Emergency entrance and dropped the kickstand. The Slocumbs' battered Ford pickup, parked nearby, was empty. For no particular reason, Matt guessed the one who had been passing out was Kyle — the most outgoing and obstinate of the eccentric Slocumb quartet.
Jeannie Putnam, wearing a set of maroon scrubs and a surgical mask, was waiting for him in the surprisingly busy ER. She was a tall woman in her late twenties, with a good grasp of emergency medicine and an obvious empathy for the patients.
"We're grateful for your coming in like this," she said.
"Which brother is it?"
"Kyle. And you were right about the other one. It is Lewis."
"Labs off?"
"Kyle drew the line at getting any tests until you were here to order them."
"Lord."
"But I changed his mind," she added with a wink. "I even got him to put on a johnny. He's really sort of cute."
"You should see the room the four of them sleep in. 'Cute' isn't the first adjective that would come to mind. But I am glad you appreciate some of his charm. What did you order?"
"The usual, CBC, Chem 12. Plus the cross-match. Tell me again why you ordered it?"
Matt shrugged and shook his head. "I don't know. Kyle's never had any medical problem that I've had to deal with. Something you said about his passing out then waking up sounded like low blood pressure, so I thought maybe he was bleeding internally."
"If you have made the correct diagnosis over the phone at three A.M., I would consider you very spooky."
"You wouldn't be the first," Matt said.
Looking absolutely ridiculous in a paisley-print johnny, grizzled Kyle Slocumb, the youngest of the brothers, nodded his approval as Matt walked through the door. Lewis Slocumb, who seldom spoke a word he didn't have to, was seated in the corner, half asleep. Matt went straight to the bedside and began his examination as he asked questions.
"So, Kyle, what's the deal?"
Skin pale, palm creases pale, nail beds pale. Jeannie might be right about his being spooky, he thought. Anemia of some sort was already at the head of the list of possibilities.
"Ah got up ta take me a piss an' got all dizzy, Doc. Lewis says Ah passed out, but he tends ta zaggeration."
"Any pains?"
Pulse thin, rapid.
"Jes the usual."
"You drinking much of that rotgut you guys make out there?"
Betty soft. Maybe a little protective muscle tightening over the stomach.
"A course Ah am. But so's the rest a the boys."
"Your stool any unusual color?"
"My what?"
"Your stool. Your bowel movements."
"My what?"
"Your shit, Kyle. Your shit."
"Oh, that. How should Ah know? Nobody in their right mind 'ud ever look down thet outhouse hole."
"Whazza story, Doc?" Lewis asked.
"I don't know, Lewis. Maybe low blood."
"You'll fix him up."
"I'll fix him up, Lewis."
Matt did an efficient but detailed physical exam that showed a significant drop in blood pressure when Kyle sat up. Low blood volume, low blood count. Anemia. Now it was time to look for a source of blood loss, starting with the most likely. Matt pulled on a rubber glove.
"Whazzat fer?" Kyle asked.
"I think you can guess, Kyle. Roll over, face the wall, and pull your knees up toward your chest. I need to see if you're bleeding inside."
Kyle did as he was asked, but the moment Matt's gloved finger touched his anus, he shrieked, stiffened his legs out, and began bellowing over and over again like a wounded beast. The staff — two nurses and the ER doc — came charging into the room.
"Ah din't think he 'uz gonna lak thet," Lewis drawled.
"Well, why in the hell didn't you say something?" Matt replied, much louder than he had intended.
Jeannie Putnam and the two others stood at the doorway, transfixed. Matt, his gloved finger pointing skyward like a fan at some bizarre sporting event proclaiming his team was number one, smiled at them sheepishly.
"I… don't think I waited long enough for Kyle to agree to this procedure. Apparently it's a touchy area for him."
"Apparently," Jeannie said. "Urn, Dr. Rutledge, can we be of any help?"
"Well, actually, you can be sure that blood you sent is cross-matched for six units, and you can tell the lab we really need his hematocrit."
"Is he bleeding internally?"
"That's my guess."
"Guess?"
"I'd be a bit more certain if I could get some stool to test for blood. Kyle, how about if I go up there with a little Q-tip?"
"Nope."
"Look, Kyle. It's three-thirty in the morning and you're sick and I have to know why. Now, either you let me do the procedure I want to do, or I promise you I'm going home and back to bed."
"What?" Kyle and Jeannie exclaimed in unison.
"Ya wouldn't leave me, Doc," Kyle said.
"Oh, but I would. Believe me, I would. Dr. Ellis here can take care of you for now, and in the morning they'll find you another doctor. That is, provided you're still alive in the morning. Now, what's it going to be?"
For half a minute, there was only silence. Then slowly, Kyle rolled back to face the wall and drew his knees up.
"Darn but yer an ornery summabitch doctor," he said. "Y'uz ornery as a kid an' ya jes got worse since then."
"I'll be gentle, Kyle," Matt replied.
By six-thirty, the impending crisis surrounding Kyle Slocumb was over. The hard-won rectal exam disclosed black stool that tested positive for blood. Perhaps cowed by the procedure, Kyle put up little resistance to swallowing a thin plastic tube, which Matt slid up one nostril and down the back of his throat into his stomach. Years of smoking potent homegrown cigarettes had done in his gag reflex, making the often difficult insertion a snap. The stomach contents aspirated through the tube were old blood (coffee grounds in appearance) and some streaks of fresh, bright red blood as well. Transfusions had quickly replaced the lost blood and circulating volume, so that by the time Kyle was wheeled into the GI Suite for an examination through gastroenterologist Ed Tanguay's scope, he had recovered his color and stabilized his blood pressure.
"So thet's it," Lewis Slocumb said as he and Matt walked together out of the ER. The dewy morning air was fragrant.
"Just about," Matt replied. "We'll keep our fingers crossed that all Dr. Tanguay finds is some gastritis. That's like inflammation of the stomach lining. If it's a little ulcer, that'll probably be okay, too."
"But if'n he got cancer he's finished."
"Not necessarily. We can cure stomach cancer with surgery. But let's not go there until we hear what Dr. Tanguay finds. We're lucky he could do Kyle so quickly."
"If'n thet doctor sez ol' Kyle has to stay overnight, Ah think he'd jes leave."
"I was thinking he ought to stay anyway, just to get some medicine for his stomach and maybe another transfusion."
"Ah tell ya, if'n he kin walk, they's no way he'll stay."
"I got him to let me do that exam, Lewis. I can talk him into staying."
Lewis Slocumb turned and looked up at Matt. The sharpness in his blue-green eyes was belied by the rest of his weathered, scruffy face.
"Wer different, Matthew," he said. "It's a way we done chose fer ourselves an' it don' mean nothin' ta us thet mos' folks think wer crazy or sick or evil. Thet is, 'til we cross the line inta their world. It ain't nothin' we enjoy doin', b'lieve me it ain't. Kyle an' me crossed thet line this mornin'. Now we want ta cross back as quick as possible. So yew make thet happen, Doc, an' we'll take our chances. Our kind, the mountain folk, unnerstand thet so long's ya don' hurt no one, ya kin be whoever ya want. Mos' people down here in town ain't none too pleasant ta us, an' thet goes fer yer hospital, too."
Matt was so astonished, he could barely reply. Lewis Slocumb hadn't called him anything other than Doc since his return with his M.D. He had also just spoken more words than Matt could ever remember.