Chapter Three
I opened the file on the computer and quickly read it, taking mental notes about the old X-rays and the patient’s past treatment for the injury.
She was my last patient before I finished reports and headed to the diner.
It was Spanish Rooster Tuesday, and there was no way I was going to miss it.
I was on a campaign to get it added to the Nightingale Diner's menu permanently.
I just had to convince Ivy Lund that it would sell consistently if she did, which meant sending as many people as possible over there whenever it was the daily special. Now, I had someone else in my corner.
Audrey Violet.
A lovely woman who had been so welcoming since I moved to town.
From what I’d come to understand, she was also the Welcome Wagon, and she’d dropped by my house to bring a housewarming basket that had included a variety of local goodies.
There was homemade jam, fresh-baked bread from the Bells Pass Bakery, a potted succulent in the cutest cactus planter that now sat on my desk, and information about the businesses in Bells Pass.
The day she stopped over, she’d told me she was off to pick up her husband for Taco Tuesday at the food truck.
My ears perked, and my stomach rumbled when I told her I’d fallen hard for the Spanish Rooster.
Audrey informed me that half the town had, so we hatched a plan to ensure the Spanish Rooster didn’t end when the food truck did for the season.
A big part of me probably wanted to see Jaelyn, too, but I wasn’t acknowledging that part of me.
It wasn’t always smart to bring those things into the light when you couldn’t have them in your life.
Was Jaelyn a breath of fresh air in my all too boring life?
Yes, but something told me she wasn’t looking for an ex-army doc blown apart by life.
Shaking those thoughts from my mind, I pulled the curtain aside.
“Hello, I’m Dr. Warren,” I said to the family waiting inside. “Are you America?”
“AJ,” the girl answered. “Just call me AJ.”
“As you wish,” I said, bowing before I shook her hand.
A man sat in a chair next to the gurney, and I shook his hand, too, surprised by the high-tech prosthesis that wrapped around mine. “I’m Dawson.”
“Nice to meet you, Dawson. That’s some fancy hardware you’ve got going on there.”
“Courtesy of the U.S. Army,” he said, wiggling his almost nonexistent fingers. “I heard a crusty ex-army doc was in town. I expected someone much older.”
That brought a smile to my lips. “Guilty as charged, for the ex-army part, at least. After a few tours on foreign soil, I decided the civilian sector wasn’t so bad.”
AJ shifted the little boy on her lap, who was busy doing something on her phone.
I pointed at the boy. “Is this little cutie your son?” I asked, tickling his belly. He must have been about eighteen months old.
“I’m barely seventeen,” she said, glancing at me sharply. “Valor is my baby brother.”
I grimaced and shifted air through my teeth. “Sorry, it’s been a long day. I should have thought of that.”
Dawson laughed. “Don’t worry, you aren’t the first, nor will you be the last. I adopted AJ a few years ago when I married her mother, Honor. She’s not here today because she’s teaching, but I’m off for the day.”
With that, everything clicked into place. “You’re the Dawson that Audrey Violet mentioned the other day. She has nothing but good things to say about you.”
“Aunt Audrey loves him,” AJ said with a chuckle.
“Well, I am rather lovable,” he teased, taking the baby off her lap. “I suppose Dr. Warren would like to hear about your situation.”
“Yes. It says foot pain here, but that’s rather vague.”
“A couple of years ago, I injured my foot,” she said.
“What she’s not saying is, she had her foot smashed while protecting her best friend from certain death,” Dawson said, as though he needed to interpret for me.
“Dad,” AJ groaned, and I could tell she was trying not to roll her eyes. “It wasn’t smashed. It only broke the cuboid bone.”
“We’ll get back to the certain death thing, but tell me, did the break require surgery?”
“No,” AJ answered. “They said it would heal if I wore a boot, which I did.”
“It seemed fine at first,” Dawson added. “It happened in November, and by the following summer, she was able to do everything, but then—”
“Then that started to change,” AJ said. “First, it hurt to run, so I stopped. Then it hurt to walk in certain shoes, so I made sure to wear ones that supported the foot. Now, it hurts to walk in anything. I can barely get through the school day. Then, today, I was in gym class. I took a step in my gym shoes, and it was like an electrical current went through my foot. I fell and couldn’t get back up. ”
“That’s a significant decline,” I agreed with a frown. “Have you been limping?”
“For quite some time,” Dawson answered. “We have an appointment with her family doctor next week because we’re sure something is wrong with it. I wasn’t surprised when Honor called me to come pick her up. Could she have sprained it?”
“She could have,” I agreed without commitment.
“Or it could be that the bones weren’t aligned quite right, and now they’re rubbing on each other, or it could have refractured.
We’ll order a scan to gain a clearer understanding of the tendons, ligaments, and bones.
There are twenty-six bones in the foot, so things need to be lined up perfectly to fit together like the puzzle they are.
We’ll get to the bottom of it. See what I did there? ”
AJ snorted and shook her head as I examined her. I pressed on the outside of her foot, and she yelped. “That hurts badly there.”
“I’m sorry,” I said with sincerity. “That spot is right over the cuboid, so that tells me a lot. I’ll press very gently on the top of the foot. Tell me if it hurts.” She nodded, so I pushed lightly on the top of a deformity that made her yelp again.
“Yep, it hurts. That’s bad, right?”
Without answering her, I carefully lifted the foot to inspect the bottom, which had turned black and blue to match the top.
There was more examining that could be done, but rather than make her pain worse and risk damaging something further, I’d get the imaging studies first. The last thing I wanted to do was manipulate the foot to the point of requiring more extensive intervention.
She would need intervention by the looks of it, but I’d rather it didn’t involve a scalpel if possible.
“It’s concerning, so I’m glad you came in. There’s a bit of a deformity here over the cuboid,” I explained, motioning over the spot without touching it.
“That hasn’t always been there,” Dawson added. “At least it wasn’t there the first summer because she wore sandals with no problem.”
“And now you can’t?” I asked, and she nodded.
“That could mean it’s a cyst or a problem with the inferior extensor retinaculum, which is a fancy term for a band of tissue that holds your tendons in place.
Let’s get some imaging done on it so we have an idea of what we’re dealing with before we go any further.
If it’s something I can help with as an orthopedist, I’m more than happy to do that.
If it’s something that podiatry should look at, I’ll page them, but we’ll get it sorted out.
I’m going to order an MRI, and radiology will come get you for it.
” I glanced at Dawson. “Can you wait, or do you need to go?”
“I’ll call Audrey to pick up Valor. Honor is teaching, but she can get here if need be.”
“No need to bother Honor just yet. Let’s get the scans, and then we’ll get back together once I have those images.”
“Give it to me straight, doc,” AJ said. “There’s a big problem here, right?”
Dawson bit back a smile as I turned to face my patient. “I believe so, yes. I don’t want to alarm you, but I’m worried the bone has fractured again, and I don’t mean a simple hairline crack. I think it’s now doing this.” I made a tent motion with my fingers.
“I wasn’t even running,” she said, a sigh heavy on her lips. “It doesn’t make sense.”
“It does if the fracture healed through malunion,” I explained.
“What does that mean?” Dawson asked, putting his phone away after sending a text.
“It means the bone wasn’t aligned exactly right when it healed, so the healed fracture wasn’t strong.
When the original injury happened, AJ’s bones were still developing.
The imaging says the fracture is healed, and the patient thinks everything is fine, but over time, that malunion starts to cause pain, limping, and deformity. ”
“Until snap,” AJ said with a frown. “I shouldn’t have been so stubborn and agreed to go in this past summer.”
“Don’t be too hard on yourself. We don’t always know if it’s just pain from an old injury, which is common, or something more.
They rarely fracture in this manner. That’s why I want to see what we’re dealing with via an MRI.
A ligament or tendon may be too tight, leading it to break in this way.
It could be that you reinjured it without realizing it.
Typically, if it’s a malunion, we go in and realign everything.
Then, we anchor the bone, so it heals properly.
I won’t know for sure until we get an MRI. ”
“Won’t an X-ray tell us that?” Dawson asked, and I nodded.
“It will, and we’ll start there, but the MRI is important.
I want to check if there’s any damage to other parts of the foot, such as tendons or muscles.
If a tendon has tightened due to the original injury and is putting too much pressure on the bones, we need to know that so we can address it.
If a muscle is damaged as a result of the break, we must also be aware of that.
I like to have the whole picture before we embark on treatment. Are we on the same page?”
“Yes, sir,” AJ said dejectedly. “I just want it to stop hurting.”
“I can’t blame you there. The nurse will start an IV, administer a shot of pain medication, and then proceed with the imaging.
Nothing to eat or drink until I know what we’re dealing with, and don’t put any weight on the foot.
You’ll go down for imaging on the gurney.
If you need the restroom, they’ll wheel you in, and you can use the grab bars. Understood?”
Her nod was immediate. “I couldn’t put weight on it if I tried. This is not cool at all. It’s my senior year, and I’ll be in a boot for half of it.”
“I understand that it’s frustrating,” I said once I sent the order through on the computer. “But better now than next year when you’re at college. Trust me, I know this feels like a huge setback, but we’ll have you fixed and back to school in no time. Okay?”
“Thanks, Dr. Warren,” Dawson said, and I gave him a nod before I left the cubicle and headed for my office. Sad as I was about it, the Spanish Rooster would have to wait.
I locked the diner’s door with a sigh of disappointment.
I’d hoped to see Major tonight since the special was his favorite, but he hadn’t made it.
Too bad. Guess I’d have to eat the plate I’d saved for him.
Mason had caught me stashing the rice in the fridge, and I passed it off as being for me, so I reminded myself to take it home as soon as I finished closing out the till and shutting down the lights.
Mason had buttoned up the kitchen before he left, so it was an easy close for me, which was good since I had to return early tomorrow morning.
It wasn't to work but to talk to Ivy when no one else was around. Tomorrow, I close on Yaya’s house, and I need to discuss my schedule with Ivy before deciding where to stay.
Motion caught my eye, and I glanced up, surprised to see Major turn away from the door. I jogged to it and flicked the lock over, which caught his attention.
“Major,” I greeted him.
When he turned back, I saw the lines of fatigue on his forehead. “Sorry, I didn’t realize how late it was when I stopped by.”
“No problem,” I said, closing the door behind him and flipping the lock over again. “I was surprised you didn’t stop in for dinner tonight since we had the Spanish Rooster.”
“Trust me, I had planned to, but work ran late. How is my petition to get it on the menu going?”
“After tonight’s turnout, it’ll be hard for Ivy to deny that it’s the most popular new dish we’ve had in years. Probably since we debuted eggnog French toast.”
“That’s good, right?” he asked as I motioned him toward a booth. He followed me but stopped short of sliding into it. “You’re closed.”
“Sit,” I ordered, to which he nodded sheepishly and lowered himself to the seat. “You look hungry. I may have saved a Spanish Rooster for you in the cooler. You know…just in case.”
He folded his hands together in the prayer pose. “Right about now, if you can produce a plate of that, I’d marry you.”
My laughter was instantaneous as I was used to those types of proposals. I got one at least once a week working in this diner, but never from anyone who had me calculating the distance between Michigan and Vegas at lightning speed.
“No rings needed,” I assured him with a sexy wink. Well, I hoped it was sexy and didn’t come off as a deranged raccoon. “I’ll go heat it up. Hard or soft shell?”
“Honestly, whatever is the easiest. I feel bad making you stay late.”
“Don’t,” I insisted. “I have nothing pressing to do.” Unless you count packing up the final bits of my past and saying goodbye to a woman I'd loved as a mother. “Be right back.”
Before he could say anything more, I tucked tail and hurried to the kitchen.
Flirting with Mr. Three-Piece Suit was a bad idea for so many reasons, and it was important to remind myself of that.
Did I love Bells Pass? Yes, with every part of my soul, but right now, the likelihood of remaining a resident here was thin.
That meant now was the time to start loosening ties, not tightening them.
Tears gathered behind my lids as I prepared his meal. The very last thing I wanted to do was leave Bells Pass, but the reality of tomorrow was settling in, and so was the knowledge that another Christmas at the Nightingale Diner was likely not in the cards for me.