Another Five Patients

By Melissa Crickard

This suspenseful story of medical fiction traces foreign medical graduate Dr. Kip Paiva, an emigrant and survivor of human trafficking in post-apartheid South Africa. Her refuge from a Zulu militant captor comes to an end, as his brutal violence has finally tracked her across the ocean. While her past catches up to her, Dr. Paiva also becomes th

• Language: English
• Publisher: Melissa Franckowiak
• Release date: Jul 18, 2019
• ISBN: 9781732585645

Melissa Crickard

Melissa Crickard is an MFA student and a practicing anesthesiologist in Buffalo, NY. Her short fiction piece, The Very Pertinent News of Gabriel Vincent DeVil, recently placed in the 86th Annual Writer's Digest Literary Fiction Awards, and her work has appeared in Nanny Magazine, Parent Co., MothersAlwaysWrite.com, Dark Ink Anthology, Fredericksburg Literary and Art Review, and the anthology Children of Zeus, among other publications. Melissa is the mother of two children, the owner of a chatty Panama Amazon parrot, and a lover of all things outdoors.

Book preview

Book I

CAITLIN KORMACK

-1-

Medicine is so broad a field, so closely interwoven with general interests, dealing as it does with all ages, sexes and classes, and yet of so personal a character in its individual appreciations, that it must be regarded as one of those great departments of work in which the cooperation of men and women is needed to fulfill all its requirements.

-Elizabeth Blackwell

Kip Paiva

Rochester, NY

The flat map was spread on the floor of her apartment floor where Dr. Kip Paiva lay, exhausted at 5 a.m. and unable to carry on another day without Tunde. Years had passed since she’d seen her son, and as she delivered the babies of other mothers she felt rewarded, yet she pulled out part of her own soul with each one she extracted from his mother. The bed was too soft, and she had no difficulty sleeping on the hard pine. Coffin floor indentured with crevices and dust and cracked wooden lineages. Dust bunnies and mites traversing them like straits, into their abyss as she slept like a giant atop them. Heavy bodied, heavy hearted. It didn’t bother her at all. Her weary back felt better, and she welcomed the grace of a few hours of sleep. Unconscious repair of her conscious mind, respite from the upheaval of running from Ajamu, and escape from her resident duties. She woke and rolled over now and looked at the map, connecting her location in one pass from east to west, and she thought of how far she’d traveled, from South Africa to New York, and the distance that still remained between her and Tunde.

She thought of it now and she prayed.

Ajamu would follow her, find her anywhere. It wasn’t only her land inheritance or the money that this monster desired. The Zulu possessed deep-rooted beliefs in their cultural traditions, and he believed Kip’s family was intensely evil. Politically. Spiritually. When he’d promised he would one day kill her and Tunde, insisting that she grant the deed to her land to his white affiliate, she’d fled Cape Town, leaving her son with the Zulu women of the townships. Women who had suffered similar abuse in their youth. Their eyes were blue-grey then with clouds of cataract, dimming the pain of the world away, their skin puckered like aged avocadoes. She remembered it now: She averted the Inkatha leader at the port in Cape Town, boarding a massive cruise ship to Oranjestead while he grew intoxicated with one of the many corrupt cops funneling guns and technology and autos to his gang. That monstrous iron majesty the size of a small city offered promise, a new life, and yet now she was homesick, longing to return.

Eight years of solace followed, eight years without Ajamu taking advantage of her to gain a greater market share in Cape Town for his organization, without his violent abuse. She was free for nearly a decade of being forced to sell the crops he grew on the outskirts of her land. She was free of being forced into prostitution.

He’d made a deal with the butcher to complete trades in one of the back rooms of a store on Bree Street. By himself, he ornamented this brothel, decorating a room whose floor was bloodied from butchering cows and calves and pigs. He examined that room for nearly an hour before he began.

Then, that same day, he returned with Christmas lights, and he strung colored lanterns around the room, and he hung panels of sheer drapery across the support beams and doorways that blew in ethereal gusts like the breath of angels. A week later, he bought beads and tinkling bells, and he had her hem them, adorning them so that they twinkled in the soft lights of the room, and he poked her with the needle every so often when the pace of her work slowed.

Now, she was free, but her fear of him never diminished. Her hope of reuniting with Tunde was passionate as she remembered the cruise ship sailing away and the smells of citrus in the briny air and the sound of the ship’s horn, leaving Cape Town.

She’d worried about his presence the previous evening.

He was almost palpable, but that was impossible. He was miles—continents, oceans—away. There was nothing better to attenuate her apprehension after an eighteen hour shift of expectations, which were always met with a measureable amount of criticism by her superiors, than living in a dream with her parents. If it were possible to be more conscious in a memory than drifting as a steward in her troubled reality, then she was—entirely aware of her Dutch mother’s optimism, her father’s patience—there in her dream. Feeling their love as they ran through the Kirstenbosch spring flowers when their brilliant blossoms were things of diverse beauty and not the tokens of sympathy and pity she came to know. Vygies and watsonias and daisies as varied in color as the three of them, blanketing the landscape with an iridescent kaleidoscope of velvety petals. Her parents swung her by her then little arms and she yelped, exasperated, but thrilled and begging for more. What a comforting illusion to be there with her father, Physesaya and her mother, too, free from anxiety, as if they had never died.

Her pager sounded and she sighed and got up and wiped the sweat from her face: the E.R. She put on her white coat and fastened her name tag with her picture and her name: Dr. Kipling Paiva, and picked up the phone.

Dr. Paiva, she said, still drowsy.

Over the line, the secretary was curt. Dr. Paiva, we need you for an emergency C-section.

I’ll be right dere.

She splashed some water on her face from the porcelain sink and shook it off her hands. Calloused instruments of her trade worn beyond their years. She dried them on her scrubs and grabbed her coffee and drove over to the E.R. Blurred conversations escalating in volume and monitors and staff zigzagging the department like insects. Dr. Keynes’ booming voice and bug eyes peering at her like a mantis. It all turned to background noise as she sipped her coffee and started to wake up. Another day on the job. Another day safe from Ajamu. But so far away from Tunde.

Dr. Richard Keynes

On the morning of April 27th, 2006, Dr. Richard Keynes told himself that if he had to pay his ex-wife another dime in child support, that he was going to kill someone. He stared at the envelope stamped in the upper left with the Monroe County Family Court insignia, and he signed the process server’s paperwork. Then he hit the up button on the elevator several impatient times in succession. Whoever said don’t shoot the messenger had never been to trial with Diana Keynes. He’d already made her the best housekeeper in the county with his alimony payments. She’d kept the lake house in Skaneateles, the Manhattan studio, and their seven bedroom spec home she’d built on a whim. Diana had asked what she’d ever done to him to make him so bitter. Was she serious? That frigid bitch had done everything short of shooting ice lightning out of her fingertips.

What was she after now? How many times did he have to pay for his affair?

He’d failed to appear in court several times, but she’d been unable to prove he’d received a summons. It was his favorite delay tactic. She might bleed him dry, but he wasn’t about to help her do it. A skinny blonde schmuck in a baseball cap had served him as he’d left the E.R.—who the hell had let that weasel past security?

Somebody’s head was going to roll.

He ripped open the manila envelope and looked at the summons to appear for nonpayment of ten thousand in support arrears to his twins. Grace and Christine were attending N.Y.U. and naturally they needed to maintain a standard of living consistent with their previous lifestyle. They couldn’t possibly be expected to live in a dorm and take public transportation like every other college freshman living in New York City. He rolled his eyes and fastened two buttons on his suit and got into the elevator.

Good morning, Dr. Keynes, said Kip Paiva.

Good morning Dr. Keynes. He repeated the benign greeting to himself in his mind, mocking the resident’s sincerity. He could’ve wiped the smile off her face right then. A dry erase board. Gone. That’s better. The morning wasn’t good. It wasn’t even bad. It was terrible. He had the nurses’ union threatening a strike and now this from Diana to one-up the suck factor on his day.

He feigned a smile and examined the resident’s name tag again, repeating the name Dr. Kipling Paiva to himself.

To the heavy set foreign graduate, he said, Good morning. Then he brushed past her, knocking her off her balance, and got off the elevator.

-2-

November 9th, 1989

Rochester, New York

Susan Kormack passed a worn teddy bear to the backseat of her car, trying to comfort her daughter as the four-year-old’s cries competed with the weather report on the radio. The emerald station wagon fishtailed right and left on the snowy street as she pulled away from Spectrum General Hospital. The weather forecast called for another foot of snow, but she heard only the child screaming for her father. She sighed as she turned left onto Main Street.

Daddy! the girl cried out, between sobs. I want to go back to where Daddy lives!

Even a toddler knew that David spent more waking hours at work than he did at home. She’d gotten another 8 p.m. call from an O.R. nurse saying he’d be late. Funny. She’d thought 8 p.m. was late. But she was married to a doctor, they’d say. She knew what she was getting herself into, right? Someday, she could buy an Oscar de la Renta for the Department of Surgery holiday party and drink Grand Marnier and shove stuffed mushroom caps in her mouth at the Monroe Country Club with David. The other 364 nights would still be reheated dinners and excuses and broken promises.

Now she loosened her own seat belt and turned around and tried to reach Caitlin, squirming off the seat.

Sit down, she shouted, and slammed on the brakes.

The car slid to a halt, but the feverish girl continued to wail as she plopped down on the back seat.

I want Daddy, the girl cried. Her blue eyes filled with tears and her nose ran with clear fluid and her barky cough interrupted her sobs.

She brushed her hair off the little girl’s warm forehead, but her cries became louder. Shhh. It’s okay.

I want to go where Daddy lives.

Daddy will be home later, she promised, although she prayed Caitlin’s heavy eyelids would be closed before they made it home. The child hadn’t slept or eaten well in three nights. Her breathing was labored. Raspy. Susan offered her a bottle filled with apple juice, but the girl batted it away like Rickey Hendersen in the bottom of the ninth.

She ducked as it flew into the front seat of the 1976 Chevy station wagon.

She pulled away from the curb and tried not to hit the minefield of potholes that shook the car, causing it to slide on the icy road. Her husband, Dr. David Kormack, a surgical resident, was busy with another late surgery, so he was unable to offer any useful medical advice or even evaluate his own daughter. She clenched the steering wheel and navigated the snowy streets and looked for a pay phone to call Caitlin’s pediatrician.

She couldn’t wait for David’s help.

April 27th, 2006

On the last day of the school year, Susan had everything ready for her students. She’d prepped them for the grueling, eight-hour test, focusing on the most frequently asked questions, and she’d spent hours staying after school to teach them.

If only their parents would set goals for them. Expect things.

The phone rang twice that morning before she left the house for work. The first call was an automated reminder from her doctor’s office about her three o’clock appointment. She figured she’d have to cancel. How was she expected to remember an appointment six months in advance, when she couldn’t remember what she was doing six hours from now?

Her students wouldn’t be done with the testing by then. In a lot of ways, things were easier when she and David were still married. She decorated the house. He paid for it. She booked summer vacations. He paid for it. Money wasn’t everything, but she wasn’t any happier sitting up at night wondering how she’d pay the mortgage on their house. Still, she swore she wouldn’t uproot her children’s lives any more than David already had by screwing his scrub tech. And that was one of the affairs she knew about.

The second call was from her older daughter, Caitlin. Susan missed the call while she was in the shower, but listened to the cell phone message as she dressed for work. Running a comb through her wavy brown hair, she cocked her head to prevent water from saturating her phone.

My flight gets in at 7:52 tonight. I’ll stay over Julie’s house and have them drop me off in the morning. Love you. She thought Caitlin sounded terribly hoarse as she hit the end button and deleted the message.

Maybe it was just the voice recording.

Caitlin was in her junior year of college at Georgia Tech. The Saturdays she’d once spent shopping with her and her younger daughter, Ashley, were now taken up by Craig Webb, a young man she simply referred to as The Boyfriend.

She buttoned her blouse and looked in the mirror and frowned and put on her skirt. Then she looked in the mirror again at her crow’s feet and realized that Caitlin hadn’t mentioned The Boyfriend, and she told herself not to get too excited. Maybe they broke up. Maybe he’d changed his major. Transferred to a college out of town. In Fairbanks, Alaska.

In the kitchen, she put on her jacket and reached for one of the many coffee mugs her students had given her over her twenty-year teaching career. They cluttered up the cupboard, but she could still connect each mug with the face of each student who’d given it to her. They were boys with acne speckled faces. Gap toothed smiles adorned with metal braces. Preteen girls trying their hand at makeup for the first time. The coffee was too strong, but she drank it black anyway and put a blueberry scone into a plastic bag.

I can’t find my gray hoodie, Ashley called from her bedroom.

Ash, you’re going to miss your bus, she called to her younger daughter. Put on something else and get down here. She gulped another sip of her coffee and pulled her keys from her purse and waited for a response before she yelled, I have to leave now.

When Ashley didn’t respond, she set down her coffee and raced back upstairs to her daughter’s room and stumbled on one of Ashley’s sweaters sprawled over the top step. Ashley was struggling to keep a C average, even though she was putting in extra hours with a tutor. Twice this semester, she’d received detention for tardiness. Caitlin had breezed through high school with straight A’s and excelled as captain of the softball team. And while Caitlin’s tall, athletic build had made her easy to shop for, Ashley had put on fifteen pounds since she’d hit puberty.

Do you have to jump off the roof to get into those? She watched her daughter struggling to fit her new body into her old jeans. No.

What’s wrong with these? Ashley examined her backside in the full-length mirror. I’m sixteen years old. You’re not telling me what to wear. Her eyes narrowed and the lump of scrunchied brown hair on the top of her head bounced when she spoke.

Kate would wrap her in arabesque arms then. The same elegant limbs that could spike a volleyball stronger than a New Year’s Eve punch of Blue Berry Kool Aid and rainbow sherbet and vodka. The bottle of Grey Goose in the freezer was only an inch deep, and she reminded herself not to go at it too hard when she got home later.

It just wasn’t this hard with Kate.

Susan brushed Ashley’s hair off her shoulders. Listen, we’ll go shopping this weekend for new jeans, but only if you promise to peel those off and get to your bus on time. Kate will be home tomorrow.

Ashley smiled. Can Kim come with us?

Don’t miss the bus again. There’s no one to drive you. I have to get to school on time. It’s an important day for my students.

She kissed her and after she hurried downstairs, she poured the rest of her coffee into a travel mug and warmed it up with a bit more from the pot. She dialed Caitlin’s cell phone, but heard her voicemail after two rings. She’d passed a few traffic lights when her phone chimed with a text message from Caitlin. Was it so hard to call?

The text read: Can’t talk now. Having breakfast with Emily. Wicked sore throat.

She’d lost her own mother to cancer more than ten years earlier, and there were times when she became acutely aware that she no longer had her guidance. She missed their talks and her advice she thought she didn’t need. Their arguments. Every last I told you so. And she wished she could talk to her just then.

As her blue Volvo pulled into the Emory Junior High School parking lot, she reminded herself to pick up some cough drops on the way home. Milk. Eggs, too. A refill on her Valium prescription. Maybe another bottle of vodka at the liquor store without Ashley seeing. As she walked toward the building, she righted her balance as she twisted her ankle to the right, but she kept walking. Her tweed skirt and silk blouse were wrinkled and she knew she looked flustered, like a covey of bobwhite quail flying in all disorganized directions, but there was no time to worry about her appearance.

Today has to go well. She repeated it to herself.

The day’s test scores would determine how much, if any, state money would be allotted toward the programs for gifted and talented students at Emory, something she’d strived to get back for the school since the money was pulled by the state several years earlier. At that time, she and David had been struggling through the divorce, and she’d lost the stamina to fight a war on two fronts.

She knew she shouldn’t, but this morning, she popped an extra Valium in her mouth as she walked past the main office.

Caitlin Kormack

Caitlin Kormack and her roommate, Emily, finished their Belgian waffles in the dining hall and walked out to the courtyard and crossed the graded lawn toward their dorm at Georgia Tech. Most of the students had already left for spring recess, but a few, mostly foreign, students remained. It was a cherry blossom morning with finches and bumblebees crisscrossing the Atlanta courtyard and spreading spring life all over it. Although she felt congested, she breathed in the floral aroma with appreciation, knowing that back home in Rochester, there might still be snow on the ground. She sneezed twice, covering her mouth.

Bless you, said Emily, handing Caitlin a tissue. Here.

She blew her nose into the Kleenex and put her hand on Emily’s shoulder as she faltered and stepped to the side. Thanks. I felt dizzy there. She stopped for a moment to regain her loss of balance. I wish I was going to Panama City with you.

You shouldn’t let Craig keep you from having a good time.

You sound like my mom. She was quiet. But I know. He and I had a big fight yesterday.

Emily looked at her directly, but she looked down. He’s way too jealous.

She only nodded. Emily pulled out her hair clip and held up her cell phone and snapped a picture of the two of them.

Say tequila, Emily said, with a wide smile.

She studied the image. Her eyes looked glassy. Half-closed. Bloodshot. Erase it.

Emily shoved the phone in her pocket and laughed. I’ll see you next week. Tell your mom I said hello.

I will. I can’t wait to see your pictures from spring break.

The girls hugged before parting ways. She crossed the street toward their dorm as she watched Emily head down the street to the MARTA station, bound for Hartsfield Atlanta Airport. Her own flight wasn’t until late afternoon.

She rubbed her stomach, now a washing machine of waffles and toast and yogurt. Even for a college student, she had a voracious appetite and could easily put down a large breakfast. She’d planned to walk up to the student athletic center after breakfast and lift weights with some of her volleyball teammates, but now she felt too tired. She walked back to her dorm room and changed into her boyfriend’s sweatshirt and closed the mini-blinds and crawled into bed.

Susan Simonick

Susan peeled the cellophane back from the stack of testing sheets as the junior high students filed in and took their assigned seats in the gymnasium. Enzo Marinucci, one of her favorite students, sat down in the front row. He was the son of Italian immigrants who were still struggling to learn English, but Enzo’s reading scores had jumped fifty percent in the last year thanks to her hours of after school help. Carmen DiTonto and Aliya Jones took seats side by side. Coke-bottle glasses and braces with colored rubber bands, both of them. The teacher’s aides passed out Number Two pencils. Sneakers squeaked against the lacquered floor. The preteens whispered and they leaned across the aisles and they folded and unfolded origami fortune tellers.

Susan smoothed her skirt and cleared her throat and pulled at her hem. The state’s coveted Lincoln Grant went to the district’s team that made the greatest improvement. If her team won the stipend, they’d qualify for college credit courses at the university. For some of her students, getting into college meant the difference between a life of dependence, violence, and poverty, and a self-sustaining, independent life.

Mrs. Simonick, can I get my glasses from my locker? asked Marcus Thompson, bunny teeth protruding over his micrognathic chin, limbs like overcooked spaghetti, hanging limp.

Sure, Mark. She smiled.

After all the children were seated, she walked to the microphone and tapped it to test its function. Reading the directions aloud, she said, Read each question carefully. Place your answers only on the answer sheet provided. Use only the Number Two pencil. Do not—

Her cell phone’s "Passionate Kisses" ring tone was her favorite Mary Chapin Carpenter song, but it interrupted her in mid-sentence and triggered a barrage of laughter from the first few rows of students. Mortified, she snatched the phone from her pocket and switched the ringer to vibrate.

That must be Kate.

She knows I’m at work.

She shoved the phone back in her purse and continued with the test instructions.

Caitlin Kormack

It’s Kate. Call me, Caitlin said, on her mother’s voicemail. She crept down the hallway in her pink bunny slippers to the shared dormitory bathroom and splashed some water on her face. An Asian girl was brushing her teeth at the adjacent sink, but Caitlin didn’t recognize her. She pulled her brush from her bucket of toiletries and she brushed her blond hair a few times and she drank some water. She walked down the hall to the kitchenette, around to the study lounge, and back up the back hall to her room, searching for a familiar face.

The dorm was empty.

Everyone she knew had left for spring break.

Back in her room, she sank down among the pillows on her bed and dialed the campus infirmary. She reached a receptionist after a series of voice prompts.

The doctor has left for the week, but the nurse practitioner is seeing walk-ins for emergencies, said the receptionist.

Where are you on campus?

We’re located at—

Wait, please.

She paced about her dorm room with obscure intent, her vision blurring with waxing clarity, as she rummaged through the clothes and books and papers scattered about the floor, searching for a pencil. She tripped over her gym bag as she rose from her bed and took another vertiginous step toward her desk chair and sat down. Can you slow down for a minute?

I haven’t said anything, dear, said the receptionist. Our address is 316 West Campus Drive. We’re on the north end of campus. We’re here until three.

Confused and groggy, she managed to locate a pen. She scribbled the address on her sweatpants in blue ink. She had understood the receptionist’s words, despite the woman’s Latino accent, but it took longer than usual to process the information.

What’s wrong with me?

I didn’t drink that much last night.

Of course. I know where that is. She thanked the woman and she left her room and she took the campus shuttle bus down to the infirmary, trying to rest her head as it jackhammered against the window for the length of the bumpy ride.

The waiting room was empty and cold and smelled sterile like a hospital. The receptionist greeted her and a young nurse led her to an exam room and took her blood pressure and temperature. When she removed her sweatpants to change into the exam gown, she noticed three flat, bruise-like patches on her shins.

I don’t know where these came from. I haven’t practiced with my volleyball team all week. She showed the nurse, who was busy writing notes on her record.

They look tender, the nurse said, touching the center of one of the quarter-sized patches with gentle pressure. Do they hurt?

She shrugged. Not at all.

Is that what brought you in today? The nurse scribbled as she spoke, her eyes fixed on the clipboard.

She rubbed the back of her neck with firm pressure and winced and moved it right and left. She figured it was stiff from the way she’d slept with it contorted against the bus window. My throat hurts. I think I might have Strep throat or something.

Under ‘Chief Complaint’ in her record, the nurse jotted down the exact words: I think I might have Strep throat or something.

Should I get an antibiotic?

How many days has it been bothering you?

Just today. My head hurts, too. My friend and I were out pretty late last night.

I see. The nurse jotted down more notes on the clipboard. Any vomiting?

Does that happen with Strep throat?

Have you been eating and drinking today? Your blood pressure is a little on the low side, but you did say you’re an athlete, right?

Yes. And I had breakfast this morning, but nothing since.

The nurse clicked her pen closed and nodded again, looking as if she had her figured out.

Okay, honey. A provider will be in to see you shortly. She left the room.

A provider? Was that a doctor? What exactly did this person provide?

She sat alone in the cold room. She remembered how as a child, she’d walk across the street to see Dr. Chambers, her father’s good friend with the glass eye that didn’t move, her pediatrician. When she and her sister were sick, they never sat in an office. Dr. Chambers knew everything about them and was available at a moment’s notice, even more often than her father. She hadn’t found a new doctor yet since leaving for college, since she’d never suffered more than an occasional cold. A sprained ankle. She still had her tonsils, her appendix. She shivered and she pulled her arms inside her sweatshirt and she considered calling her father. He was probably too busy to take her call. Meetings. Surgeries. Speaking engagements. All of those came first.

But he was