Chapter One
Underlying Cause
Thirteen Years Later
“Dr. Mills, there is a mother and child that came in a few minutes ago. I’ve got them in bay six. The boy looks to have a broken wrist and the mother a bruise on her face.”
He sighed; he knew what this was about. He’d seen it one too many times.
“Did they say what happened?” he asked the nurse. He looked at her nametag. It wasn’t easy to get staff on the island and he knew that many times nurses were sent over from Boston to fill shifts. It was standard but made it hard to keep people straight too.
He’d left Massachusetts General years ago because he saw way too much of this.
It was going to be everywhere—he knew it—but he wanted a more quaint setting. Not as many urgent and hard cases that burned him out. A place that let him spend more time with his patients trying to make a difference rather than slapping Band-Aids on wounds and rushing to the next open gash.
As his father once told him, “If you wanted to spend time with your patients then you shouldn’t have become an ER doctor.”
He knew that too. The same with his twin, Carson, who was a radiologist. Patients were in and out most times and moved on to the next.
It was a balance. He had to not get too attached. Get just close enough to help but not get drawn in so much that he’d go home stressing.
“The mother is claiming the kid fell off his bike. The kid isn’t talking much.”
Classic signs of abuse. “And the kid. What is he saying? Nothing at all?”
“I asked a few times and he keeps looking at his mother before he answers.”
“I’ll see what I can get out of her. What about her face?” he asked. “Did you question her there?”
“I did. She said she tripped running to him and bumped into the wall.”
“Not very original,” he said.
“Especially since they’ve been here before,” the nurse said.
He pulled his laptop closer to him that was on the stand he pushed around. “Thanks, Molly.”
She smiled at him, her face blushing some. He pegged her for early thirties. Probably a few years younger than him, but he wasn’t interested.
The ER was busy, as it normally was, but wasn’t slammed. He’d finished up with a patient forty minutes ago that was way too thin for anyone. He knew an eating disorder when he saw it and the husband brought her in for stomach pains.
After multiple tests and labs, he sent her out with a prescription for heartburn. That wouldn’t do much with the damage to the esophagus from all the vomiting the woman had been doing over the years. Her teeth were decaying and he knew his cousin Coy Bond would cringe looking in that patient’s mouth in his dental office.
The nurses discharged her and would give her information to seek help, but chances were it’d get ignored.
Just like this case might too. He was going to try harder and then not beat himself up later if he couldn’t get through to the woman.
He moved down to the bay where his next patients were and pushed the curtain aside. There was a kid that looked to be no older than seven sitting on the bed with his head down whispering to his mother, tears on his face.
“Hello,” he said. “I’m Dr. Mills. It looks as if you’ve got a wrist injury?”
“My son fell off his bike,” the mother said.
“And you are?” He looked at his computer. “Carolyn Murphy?”
“Yes,” Carolyn said. “This is my son, Ronnie.”
“Nice to meet you, Ronnie. Tell me what happened.”
The little boy looked at his mother, who said, “I told you, he fell off his bike.”
“Mrs. Murphy, it’s standard procedure to ask the patient their side of it. I’m trying to understand how fast he might have been going. Did he hit a rock and fly off the front? Did he feel lightheaded and fall off to the side? Maybe there is something more that could have caused the wrist injury that we need to figure out before he gets on a bike again.”
“Oh,” Mrs. Murphy said.
“Ronnie, did you fall off the front of the bike or to the side?”
Ronnie looked at his mother. “Off the side.”
“Okay,” he said. “Did you hit your head or any other part of your body when you landed?”
He was looking at the kid who was in shorts and a T-shirt and there wasn’t one other scratch on him that he could see. Nothing that would show he fell off a bike. No grass stains on his clothes or skin. No abrasions.
“No,” Ronnie said quietly. “Just my wrist.”
“Can I see your hand?” He reached for the kid’s hand. “Can you feel me touching your fingers?”
He was only lightly grazing them and getting movement in return, the kid flinching. “Yes.”
“Good.” He looked at the kid’s palm. “Did you land on the grass or pavement?” Ronnie looked at his mother. “It’s an easy question,” he said, smiling.
“Grass,” he said.
The kid’s hand and fingers, even his nails, were extremely clean. No way he was given a shower first, let alone his clothes changed or nails cleaned if he landed on the grass, which to cause a break would have kicked up dirt.
“Okay,” Hudson said. “We need to get you down for some X-rays, but it looks as if you might have broken your wrist in the fall.”
Mrs. Murphy started to cry. “It’s my fault.”
“How is that?” he asked.
“No, Mom,” Ronnie said. “It’s mine. I know better. I won’t do it again.”
It was the first time the kid’s voice was stronger and maybe he could get through that way. “I’m going to have a nurse come in and bring you for X-rays in a minute.” He turned when the curtain opened. “Looks like it’s good timing. Molly, can you take Ronnie for X-rays on his wrist?”
“Sure can,” Molly said. “You get to ride in a wheelchair.”
“I can walk,” Ronnie said.
“I know you can, but this is more fun and then we don’t have to worry about you tripping and falling and hurting your other wrist or banging your head,” Molly said with a smile.
“Protocol,” Hudson said. “And it’s fun.” He leaned down closer and whispered, “Don’t tell anyone, but sometimes when it’s slow here at night the doctors have races in them.”
Ronnie giggled as he was pushed out of the room, leaving him there with Mrs. Murphy. “Thank you,” she said.
“Let me look at your cheek,” he said.
“It’s fine. Just a bruise. I’m clumsy.”
He hummed in his throat. “Maybe there is a reason for that,” he said. “Are you lightheaded at times? There could be an underlying cause for it that shouldn’t go untreated.”
“I’m fine, Dr. Mills,” Mrs. Murphy said.
“I’m going to be frank then,” he said. “Your son has been in my ER three times in the past fifteen months for injuries. Each time you’ve had similar injuries or bruises. You’ve been here six times in the past two years.”
“I’ll repeat,” Mrs. Murphy said, “I’m fine.”
There wasn’t much he could do at this point. Not until he got the results from the X-ray.
He walked out of the room and went to another patient. That was what he did. Moved from one to another.
An hour later, his phone buzzed and he looked down to see it was his brother, Carson. It was late afternoon and Carson had started his shift two hours ago; Hudson would be leaving in a few hours. They tended to cross over a lot rather than working together.
Since they both lived at Hudson’s house, it’s not like he didn’t see his brother, but not often either.
As twins, they were used to being around each other except for the year he was here and Carson was still in Boston.
Hudson had gotten his position first when it opened, Carson a year later. He’d had his house and, rather than Carson trying to find a place to rent or buy one, it was easier to have them splitting the bills.
It was that or Carson staying with his parents who had a house on the island. That was what Hudson did at first since his parents weren’t always around.
Now his father was a semi-retired surgeon filling in one week on the island and then the same at Mass General where he’d spent more of his career. The other two weeks he was on call or filling in as needed.
Their sister, Ava, was an OBGYN and worked at a satellite office in Plymouth until she relocated to the island permanently too.
Funny how they were all born and raised in Boston and only vacationed here and now resided on the island. The island was different than it had been when they were younger.
It had more to offer. There were plenty of transportation options and it provided a quieter life that he knew he wanted. More like knew he needed.
He texted Carson back that he was available to talk, but he knew what his brother was going to say.
“Hey,” Carson said, coming down to the ER. “Got a room to chat in?”
“Follow me,” he said. “You could have told me the results were ready for me to read. I know it’s a break.”
“It is,” Carson said. “It’s not from a fall but from a twisting motion. What’s going on here?”
“Domestic abuse,” he said. “I know it and the mother knows I know it. The kid isn’t talking.”
“I had him talking,” Carson said. “We were talking baseball to relax him.”
“Did he tell you he fell off his bike?”
“He did,” Carson said. “But I knew it was a lie when he wouldn’t look me in the eye.”
“Not to mention there isn’t another mark on him,” he said.
“No,” Carson said. “What are you going to do?”
“I’ve tried to be subtle, but it’s not working. Got a minute to go in with me to give the results?”
“I do,” Carson said.
The two of them walked into the room where Ronnie and his mother were. “I told you, Mom, there are two of them.”
Hudson grinned. “That’s right,” he said. “This is my brother, the other Dr. Mills. He took your X-rays.”
“I’m sorry to say that you’ve got a compound fracture,” Carson said. “Sometimes a simple break can be put in a cast, but due to the nature of this injury and how it occurred, Ronnie is going to need surgery to put a pin in it.”
Mrs. Murphy started to cry some more, Ronnie too. “But I only fell,” Ronnie said.
“Ronnie, we are doctors and can tell how an injury occurs most times from an X-ray,” Carson said. “Your wrist was twisted, you didn’t land on it.”
Ronnie started to cry louder.
Hudson leaned toward the mother. “Is there somewhere we can talk privately, Mrs. Murphy?”
“Yes,” she said, sniffling.
“Follow me,” he said, Carson staying with Ronnie.
“We have a few options here. I can call the police and have you charged with endangering the welfare of a child. I’m not sure if you broke his wrist—”
“No!”
“Then someone else did. Maybe the same person who put the bruise on your face?”
“I can handle it,” she said.
“You clearly can’t. We are here to help you. I can’t do that if you aren’t being honest with me.”
“It’s not that simple.”
“It never is, but there are resources for you. We have someone here at the hospital to help. Just give me the word and we can make it happen. We can get you safe and secure now.”
Mrs. Murphy looked unsure, but he felt he was getting through to her. “I don’t know.”
He opened the door and found another nurse and waved her in. “Can you please reach out to Delaney to come in here ASAP?”
“Delaney?” the nurse said.
“She’s the new patient services coordinator. I read the memo a few weeks ago. Her number should be at the desk.”
“Sure,” the nurse said.
“Someone is going to come in and talk to you and give you some options. I can still have you charged. I can have whoever did this charged too. Whether charges are dropped or not is your choice and a headache regardless. Or you can take a step and get you and Ronnie out.”
“I’ll talk to her,” Mrs. Murphy said. “It’s the best I can do.”
He nodded and then led Mrs. Murphy back to Ronnie. “We need to schedule surgery for your son,” he said. “We can do it here tomorrow, or get you to Boston via a chopper and into a safe place now.”
“Really?”
“Yes,” he said. He’d make it happen somehow, even if he had to call his cousin Egan and ask for a personal favor. He needed to get a good outcome today. He needed to feel like he was finally making a difference.
“Thank you,” Mrs. Murphy said.
Natalie Ann 