*Author's note: Yes, I realize that the character in this episode is named Karthey. I did it on purpose.-KM
Kate Sykora ran a hand over her forehead as she dismissed the day's first patient with a smile. Clinica Sanando certainly kept things interesting at a mile-a-minute! Yet the breakneck pace the walk-in clinic functioned at was exactly Kate's style. She thrived in being able to dash back and forth from lobby to exam room and back again, knowing that each time, a person could walk out feeling better than they had in a while.
Zeke Barnes, her coworker, joined her at the front of the lobby as Kate found herself immobilized by the sight of all the people still waiting—and it was only eight in the morning!
"Where do they all come from, do you think?" he murmured in her ear with his usual cynical grin.
Kate found Zeke's typically morose demeanor invigorating. It challenged her to keep a positive outlook, and never failed to make her feel better when she could.
"I dunno, Zeke," she returned with a grin, "I'll bet they ship them here from every hospital on the eastern seaboard, just for us!"
Zeke smirked and grabbed the next two patient files. He handed one to Kate after peeking at the information, "Oh, look, this one's from way out on the coast of 'Just Down The Street.'" He shook his head and stepped toward the waiting room. "Enjoy your out-of-state visitor!"
Kate peeked at the name, and stepped forward to call it, "Uh, Karthey Devanne?"
"She's over here," a grey-haired woman raised her hand. Next to her crouched a young woman who had one arm over her stomach and one hand on her head. Kate wove her way through the crowd to get to the woman.
"Can she walk?" Kate asked.
Mrs. Devanne nodded. Karthey looked up, her face twisted into a grimace. "My head hurts, and I feel really sick," she moaned.
Kate gently guided Karthey to her feet by her shoulder, "Okay, let's get you into an exam room." She looked up at Autumn, who was still accepting forms from patients walking in and answering the phone as it rang. "Autumn, do I have a room?"
Autumn glanced down at a stack of paper. "Number Two is open," she said.
"Okay, thanks."
Just outside the exam room, Autumn grabbed Kate's arm, "Oh, Dr. Kate, about that one—" she let her voice trail confidentially, and Kate allowed Mrs. Devanne to help Karthey into the room and close the door.
"What is it?" Kate asked.
Autumn flipped open the file in Kate's hand to the medical history form. Kate saw current information, such as date of birth, address, nature of problems—but a lot of the medical history was left blank. She frowned; what sort of person wouldn't know basic medical information, both family-related and personal?
Autumn shrugged, "I tried to tell her that we needed more information, but she kept trying to tell me that's all she knew. The mom has Medicaid, but that's all I can find. There's no dad," Autumn glanced at the door, "and how can someone so old have a girl so young?"
Kate shook her head at the receptionist, "You've been here for a long time, Autumn," she remarked, opening the door, "you should know when not to judge."
Autumn rolled her eyes and returned her duties at the desk.
Kate meanwhile, now found herself in the position of having to confront the mother and daughter about the mystery, and she did so head-on.
"So, Karthey," she looked down at the file, "You say you've been having headaches," she flipped the form around to show the girl, who by now had both hands wrapped around her head, "but my problem is those headaches could be a million things, and we need more information about your medical history to know what to rule out and what conditions to consider."
Karthey dropped her hands, but still behaved as if her head was too heavy to lift. "I'm sorry, ma'am," she said quietly, "It's like I told the lady out front, I wrote as much as I knew."
"Well, if you didn't know how to answer some questions," Kate persisted, adding most of which are easy enough, in her head, "why couldn't you ask your mom?" She pointed to Mrs. Devanne.
Karthey massaged her temples and finally looked up at Kate. "That's not my mom," she admitted, "Martha's my guardian. I'm a foster kid." Karthey grimaced again. "Please!" she begged, "I've had the worst headache of my entire life for almost two weeks now, and I've tried every kind of pain reliever I could get: Advil, Tylenol, Excedrin—nothing works! Can you help me?"
Kate balked, but the more she watched the pair, the more that stubborn streak inside her wanted to say "Heck!" to the rules and help her anyway, regardless of the risk. At the very least she could get the girl a more effective analgesic!
Kate nodded at Karthey, "Okay, I can help you." She went to the linen cupboard and pulled out a fresh gown. "Go ahead and take your shirt off and put this on while I get an IV ready for you," she instructed, "I'll be right back."
Kate left the two women in the room and went down the hall to the storage room. She grabbed some saline solution and Toridol.
When she returned to the exam room, Karthey was dressed in the gown she had given her, while Mrs. Devanne folded Karthey's clothes neatly on her lap.
Kate showed them the medication, "Okay, this is just a generic painkiller called Toridol, sort of like liquid Tylenol, but the IV will get it straight to your system, so it should be a lot more effective than oral medication."
She turned to Karthey, "Let's get you hooked up. Are you allergic to iodine?"
Karthey held out her right arm as Kate beckoned for it. "I don't know; I don't think so."
"She had a nasty cut once," Mrs. Devanne offered, "and I cleaned it with iodine and Karthey didn't have a problem."
Kate nodded, "Okay, sounds good." she brushed the inside of Karthey's elbow with the bright-orange ointment and, to draw her attention away from the needle, she asked, "So how did you two end up together? Did Martha know your birth mother?"
Karthey shook her head, deliberately avoiding the sight of her arm as Kate inserted the IV needle. "Nobody knew who my mom was. Martha says she was a Jane Doe."
Mrs. Devanne spoke up, "I had wanted to be a foster mother ever since my husband died. Our five children were all grown and had families of their own. I guess I was a bit of an empty-nester, you might say. I knew a lot of the staffers at a local foster agency here in New York, so once I knew I would be alone at the house I just sent them word that I was open to any child for which they could not find a suitable home, if they deemed I was then suitable for the child." the elderly woman sighed and tucked a loose wisp of hair behind her ear. "A few lonely kids found their homes under my roof until circumstances changed and a better fit was found elsewhere." she chuckled, "I could give kids a good home, but I couldn't quite give them everything, if you know what I mean, Dr. Sykora."
Kate nodded; if the woman qualified for Medicaid, it was a wonder she thought she had enough to give kids that weren't even hers. It certainly spoke volumes to the young physician of the older woman's compassionate heart.
Martha smiled at Karthey, who had finally begun to relax as the Toridol dripped into her system and took effect. "Then one day one of the advocates called me up and said, 'Boy, Auntie Devanne, I've got a case that's right up your alley!'"
Kate smiled too, "And Karthey came to be your daughter?"
Mrs. Devanne nodded, "She was just a little thing, only two weeks old, born to a Jane Doe, they said, who had just died in the hospital before they could find out who she was. So I got Baby Doe, and I polled my kids for a name for their new sister, and one of my daughters came up with the name Karthey Anne." Mrs. Devanne came and stood by her foster daughter's side and clasped her hand. "And she's been my Karthey Anne ever since."
Kate noticed the first glimmer of a smile on Karthey's face, and she pointed to it. "Now there's something I like to see!" she cried, "Are you feeling better?"
Karthey laughed and leaned back against the pillow behind her. "Yes!" she sighed gratefully, "I think the IV worked; the pain is gone. It feels so good to be normal again, Dr. Sykora."
Kate laughed, "Okay, you guys can call me Dr. Kate. Now, Karthey, would you mind telling me how and when the headaches and nausea began?"
Karthey pursed her lips, "Well, the nausea didn't come until two days ago, but the headaches started about two weeks ago.
"I was camping with some friends, and one night I woke up with this incredible pressure in my head. I rolled over, and the pressure went away. I thought it was just because I was on a sleeping mat instead of a mattress, and that it would go away as soon as I got home." Karthey frowned, "But the pain only got worse. Two days after I got home, I could only lie on my back. Then the pressure would build up every time I lay down, so I tried sleeping propped up with pillows. Then the pressure was constant, even walking around throughout the day. I couldn't concentrate at school, I couldn't study at home, it was so bad!" Karthey glanced at Martha, "I literally felt like a full-grown person was sitting on my head all day long, and all night. Like I told you before, no amount of medication I tried did anything at all to ease the pain, and just yesterday morning, I woke up and the first thing I wanted to do was hurl."
"You threw up?" Kate asked.
"At first I thought she must have picked up the flu," Mrs. Devanne added, "so she stayed home from school and rested, and didn't eat. But this morning, about three A.M., I found her heaving over the toilet again, only this time she had nothing in her stomach, so it was just dry heaves. Then I knew it must be a problem that we could not handle by ourselves."
Kate frowned. The pressure in the head, and the vomiting (probably induced by the pain)—nothing sounded at all like any sort of recognizable condition. Usually, when a patient began describing symptoms, Kate was smart enough to come up with a litany of diseases by the first three, and as the patient continued, weed out the most unlikely one by one till they arrived at the right one. But Karthey's condition was beyond her; it sounded like a problem for Dr. Michael Holt. But he wasn't due for another hour, if he was in a good enough mood today to show up at all.
Karthey looked up at her, "Dr. Syk—Kate," she asked, "Do you know what might be causing the headaches?"
Kate sighed, "Well, I'm not a specialist, that's for sure," she said, "but we have a doctor who specializes in that sort of thing who volunteers here. He should be here in about an hour. He would be able to help us out." She slipped on a pair of gloves, "Maybe a closer look and a little feel around your head would give us a better idea."
Kate reached around the back of Karthey's neck, feeling her scalp carefully, "So I know you're not in pain right now," she began, "but when you do have the headaches, where is the pain?"
"All over," Karthey replied without hesitation. "It's like giant hands are squeezing all around my head."
Kate's inspection reached the area behind Karthey's ears, and she felt a large irregularity on Karthey's right side. "Karthey, what's this?" she asked the patient.
"Oh, that?" Karthey picked her head up and looked at Kate, feeling the lump for herself. "I don't really know what that is. I've had it since I was a baby. I always thought it might be a bone growth or something. Do you think that's what's causing the headaches?"
Kate glanced at Mrs. Devanne for some explanation, but the older woman shrugged, "I don't know what the lump is, either. She came that way from the hospital. They told me the baby had experienced slight head trauma at birth."
Now Kate was very confused. This was not something she was used to; it didn't feel like a bone growth at all. If Kate didn't know any better, it felt more mechanical than biological. But what on earth could it be? And how could a hospital dismiss it as "head trauma"?
"Not that it probably has anything to do with her headaches," Mrs. Devanne remarked, "but Karthey also has a two-inch scar on her chest. It was almost the length of her abdomen when she was a baby."
Kate raised her eyebrows; this was definitely unheard of: a mechanical "growth" and a two-inch scar, on a baby, and no one attaches any sort of significance till now? She turned to Karthey, "Really?" she asked.
"Yeah," Karthey gestured to her chest, just below her sternum. "It doesn't really even look like a scar. I always thought maybe my skin had developed that way."
Kate sighed; she knew that the one thing that would tell them the most about what was going on in Karthey's head would be an MRI or at the very least a CT scan, but the clinic had neither. She could keep Karthey supplied with Toridol, but if they really wanted to get to the bottom of this mystery, she could not wait for Dr. Holt to arrive.
"I'm going to go make a call, Karthey," she told her patient, "You can wait right here, I'll be back."
"Okay," the girl replied, "thanks, Dr. Kate."
Kate smiled, "No problem," she said, and left the room.