The Color of Rock: A Novel

little.

Chapter 1

For the second time that morning, Abby resisted the urge to swerve from her jogging path and cross the road, to cut through the sun-spattered woods and follow the deep pull of gravity she felt from the canyon, to go gaze again into those burnished depths, those shattered cliffs. She reminded herself that the canyon wasn’t going anywhere and there would be plenty of time once she was settled to ponder those elaborate layers, sliced open like the most astonishing confection ever fabricated. The incense of pine filled the air, and the soft slapping rhythm of her sneakers steadied her mind.

Starting over was no small thing.

Starting over after nearly losing yourself, even more.

Early light splashed her face through the trees as she reviewed her relaxation mantras. There would be no room for anxiety today. Breathe deep, and capture the day.

Abby moved past the campground as tourists began to rise, the fragrance of coffee and bacon drifting through the woods. Glancing over, she imagined who might show up in her clinic that morning. That paunchy middle-aged man, struggling to lift an overloaded ice chest into his truck, was at risk for a bad back strain. That older woman, hunched at her picnic table sucking on a cigarette, had the gray complexion of a heart patient, and this altitude could easily trigger her angina.

No distractions, she chided herself. She dropped into a walk, panting softly in the thin air at seven thousand feet—a drastic change from Phoenix. Hurrying into her house, she skimmed off her running clothes and showered quickly, pulled her chestnut hair back into a messy bun. Maybe a little severe, but very professional. As she strode out the door, she fingered the shiny new key in her pocket, the key to the back door of the Grand Canyon Clinic.

She was early, staff just arriving. First days were rarely good days for Abby, who realized she was too cautious, too self-critical. Her recent loss of confidence didn’t help, but she knew herself well enough to understand that the only way past it was through it. Abby swallowed hard and introduced herself to the busy nurse who was straightening supplies in the exam rooms. It felt like home, the familiar smells of antiseptic and soap, the spotless floors and counters.

Dr. Wilmore, she said, shaking the nurse’s hand. Abigail Wilmore. But everyone calls me Abby.

Dolores Diaz, the nurse replied, taking Abby’s hand warmly in both of hers. She was fiftyish, stout, her kind face framed by short dark hair laced with silver. Welcome to the asylum! I’m so glad to meet you. I’ve heard such nice things.

Really? Abby smiled. Rumors, most likely.

Come on, follow me. I know Dr. Pepper is anxious to see you.

Abby kept a straight face. In his place, she probably would have changed her name. Dr. Pepper—how could he tolerate the inevitable teasing, such a convenient source for witless puns? Dolores led her down the hall to a small office crammed with two tiny desks, the shelves stuffed and messy, overflowing with papers and medical journals. Everything looked unbalanced and dangerously close to collapse.

John Pepper, the clinic supervisor, unfolded his lanky frame and extended his hand, his light blue eyes coolly appraising. Abby tugged her white coat straight. She didn’t always wear a white coat at work, but today she needed that shield, that universal symbol.

You’re early. I like that. He smiled nicely enough, a little guarded, the cautious smile of a cynic.

He couldn’t be more than five or six years older than her, she thought. Dressed casually, he had thick brown hair, a bit long and unruly, and he looked too thin—his jeans clung to his hips like a bull-rider’s. All he needed was a silver prize buckle, Abby thought. She gave his hand a strong squeeze.

One of my few assets, she remarked lightly. Being on time.

It’s a good one. I know some people think I’m too . . . demanding. For being out here on the edge of the world, as we are. But it’s a slippery slope if things get too loose, so I’m a little bit all about the rules, I’m afraid.

Was he looking for a reaction, or was she was imagining it? Abby had been honest with him about her problems when she applied for the job, so she hoped he wasn’t having regrets.

I’ve made some room here for your books. He indicated a shelf, an open space a few feet wide. You’ll probably need more, but this is yours for starters.

Abby shook her head and pulled her computer tablet from her pocket. I only have a few books, mostly for procedures. Everything else is online. You know, like DynaMed.

Right, he nodded. I still need DynaMed.

It’s based more on scientific evidence, Abby pointed out, feeling a need to prove something.

So I’ve heard. You can apparently show me a few things. That’s good. He smiled again, more kind this time. Anyway, I’m off today for admin work—sometimes I get more done at home. Less distraction. So I’ll get out of here and leave the place to you. Dolores will take good care of you in the back, and the women up front will show you all about the scheduling and billing. You’re familiar with our electronic records program, right?

Abby nodded.

Okay then. I know you’ve got my number, so let me know if you have any problems or questions. And if things get crazy—and believe me, they can get crazy really fast—just call me. I’m only a few minutes away, and I’ll be sticking close by until you get your feet under you.

He left abruptly, and just like that there she was, alone on her first day at her new job. His swift exit surprised her, left her feeling adrift. Fine, she didn’t need him. She reminded herself that patients here were like patients everywhere, and that she knew what she was doing. Their bodies were put together in the same ways, and malfunctioned and fell apart in the same ways, no matter where. Cells were cells: blood flowed or didn’t flow, hearts beat steadily or not, intestines digested, kidneys plumbed the waterworks, and lungs pulled in air and let it out.

Efficient and funny, Dolores gave Abby lots of tips. Some people didn’t believe in tetanus shots, but everyone would want antibiotics for everything. Some tourists started drinking early, so those injuries might show up by noon. And there was a heat wave coming, so get ready for dehydration and heatstroke. Besides the incidental illnesses and injuries of tourists, the clinic also managed the routine health care of several thousand people who lived and worked in the area.

Abby had only seen one patient, a woman with sciatica, when Debbie from the front desk leaned into the hallway and called out in a mournfully loud voice, Trauma coming in! Three minutes! Gunshot wound.

Of all things on her first day. Incredible, Abby thought. Dolores glanced her way, threw her an encouraging smile and said, Buckle up.

Abby’s pulse had jumped up her throat. She nodded back at Dolores and stepped into the tiny office, her back to the door, and took a moment to focus. You’re fine, she told herself, you can handle this. She closed her eyes and slowed herself down, inhaling a long, deep breath. She pictured the oxygen molecules as they trickled in through her nose and tumbled down inside her lungs, imagined the red blood cells snatching up the oxygen and swapping out their carbon dioxide, releasing it as she exhaled. Her pulse slowed a little.

Capture the day, gunshots and all.

The door crashed open, and the hall suddenly filled with uniforms and a stretcher. A noisy crew of men surrounded her with sweat and boots, calling out vital signs and looking her way, checking her out.

Hey, new doc!

Nice to meet ya!

Welcome to the canyon!

They wheeled the patient to the trauma room, and Abby pushed her way to the head of the stretcher. A thin sallow man in his forties grimaced and groaned, reaching for his leg, which was elevated and wrapped heavily in dressings. An IV was already running.

What’s the story? she asked.

A ranger introduced himself, grinned cheerfully, and consulted his clipboard. Short and burly, a thick neck and close-cropped dark hair—the ranger looked like a small bull, but he touched the patient gently, calling him by name and restraining his arm to keep him from grabbing the bandages. Dried blood coated everything, flaking on the sheets, staining the patient’s hands and sleeves, crusted on his foot, and saturating his jeans, which had been cut off at the thigh on his injured leg.

Well now, the ranger drawled happily, planting his feet and grinning at Abby. This here fellow just drove up to the rim last night and set up his camp around midnight. Hang on, Matt, let go of that. Anyway, he was worried about the wildlife—you know, the vicious chipmunks and possum and such—so he decided he’d better keep his sidearm strapped to his hip this morning when he visited the john. Matt, listen to me, lie still. Only problem was that when he was pulling up his pants something got tangled with something else and boom! That big old pistol fired itself right into his calf. Looks like the bullet went clear through, but man, there’s a lot of blood on that outhouse floor right now. I mean, a whole lot. I’m glad I’m not on the cleaning crew.

Abby settled in, adjusting IV fluids, ordering labs and X-rays. She gave the patient morphine, and he began to relax. Fortunately, the wound had nearly quit bleeding, but he was seriously anemic and would need to go to Flagstaff Medical Center for a surgical wound flush and possible blood transfusion. The patient, now dull with narcotic, sleepily protested the transfer because it had taken him a year to get that campground reservation, but he was overruled.

The rangers cleared out, and Ginger up front called for an ambulance.

Ready to jump back on the treadmill? Dolores asked, smiling and pointing to the next exam room.

Abby nodded. She was no stranger to a busy pace, and preventive visits were her favorite encounters. She relished the task of keeping her patients healthy, finding the tiny abnormalities before they became bigger problems. Uncovering the destructive habits and searching for what might change the course. Endlessly challenging and sometimes rewarding. Her next patient had waited a long time because of the trauma case: Ada Cheshire, a cheery, obese fifty-five-year-old woman who drove a shuttle bus up and down the rim, carting tourists to the far western overlooks where traffic was no longer allowed because of congestion. She was new to the job, just six months.

Here for my yearly Pap! Mrs. Cheshire announced loudly, pulling off all her clothes and shedding them on a chair before Abby could step out of the room. Nah, don’t leave. It’s just us gals. My first time with a lady doctor, and I think I like it. Dr. Wilmore, was it?

Abby quickly handed her a gown and sheet to cover her ample body. Mrs. Cheshire, I don’t know if you realize, but Paps aren’t recommended every year anymore. Only every five years at your age, if your past Paps have been normal and if you don’t have HPV. HPV is that virus that causes cervical cancer.

Say what? I’ve got a virus in my hoohaw? She stopped undressing and her eyebrows shot up.

Abby smiled. No, I’m saying you probably don’t, since your Paps have always been normal. We’ll test for it to be sure.

Honey, I think I’ll just stick with the old yearly schedule for now. Because I’m ready for this Pap, and I’ve cleaned up for you down there, so let’s do it. One of her dimply breasts kept slipping out of the paper gown, which was not large enough to contain her, so Abby handed her an extra gown to cover her front.

We’ll do it today for sure. Abby knew not to push new information too quickly. And when was your last mammogram?

Nope, nope, none of that for me. Her head wagged. I’ve heard terrible things about those mammograms. Why, honey, they can actually cause breast cancer! Besides, I heard they hurt like the devil.

They do hurt a little. Abby nodded. But in reality, you’re more likely to get breast cancer, family history or not, than cervical cancer. For you at your age, a mammogram is more important than a Pap. And mammograms don’t cause cancer, by the way.

Well, I’ll think about it, but no promises, because I’d probably have to drive all the way to Flagstaff to get the dang thing done. And let’s get on with this, ’cause my shift starts in thirty minutes. She plopped herself on the table with a loud groan and flopped her legs open wide.

Abby grabbed the sheet to cover her lower half. A few minutes later, after changing to a longer and wider speculum to accommodate the woman’s large proportions, Abby finally located the smooth shiny cervix, peeking at her from the top of the vagina, and swabbed for the Pap.

Whew. Glad to have that over. Mrs. Cheshire heaved herself upright and wiggled off the table, casting aside all the drapes from her pink podgy body and reaching for her clothes. And you know what, Dr. Wilmore? I think I will take a year or two off, since you think it’s okay.

Excellent, said Abby, taking the specimens and sliding discreetly out the door. And I’ll leave you a list of all my recommendations, like the mammogram.

The rest of the morning was similar. There were blood pressures behaving nicely and blood pressures behaving badly, and medications had to be adjusted. Some diabetics were managing well, but most had sugars off on a rampage, creating havoc. A few tourists with minor complaints, ruddy rashes and puffy knees and watery bowels. A fairly slow day, Dolores commented. Abby took a moment to meet the two women at the front desk, bubbly red-blond Ginger, who laughed easily, and her somber counterpart Debbie, whose straight black hair fell in a thin curtain to her waist. Debbie never once let a smile crack her face, and her ghostly pale complexion made Abby think of vampires. They were signing out the last morning patient when Debbie leaned into the hallway for the second time, calling out despondently, Trauma coming—ten minutes! MVA, four patients!

Dolores appeared, shaking her head sourly and motioning Abby over. We’ve asked her before not to do that. She should come back and tell us, not bellow down the hall like a cow. Dr. Pepper would be upset—she wouldn’t do that if he was here.

Really? thought Abby. That’s what Dolores was worried about? MVA meant motor vehicle accident, which could be anything from a neck sprain to a fatality. She felt like the morning might never end. And it wasn’t ten minutes, the time estimate was wrong, because the doors banged open immediately, and patients and rangers clattered in. So much for relaxation mantras—Abby barely had time to snatch a breath. The worst of the injured went to the trauma room, and Abby found herself there again without even feeling her feet move. People were moaning or calling out or talking on their phones while the rangers asked questions and filled out reports. Dolores was directing supplies to those who needed them while holding a crying woman’s hand.

Hey, Doc Wilmore! That’s you, right? A ranger stood at her side, adjusting the IV of the elderly man on the exam table, slipping oxygen prongs onto his face. The patient breathed shallowly, carefully, as if each inhalation hurt, his worried eyes darting back and forth. Might be a broken rib, or maybe a pneumothorax, the ranger was saying. He was driving along minding his own business when the other car crossed the line and smacked him head-on. Hit his chest pretty hard against his airbag.

Was the other driver drunk? Abby wondered aloud. She turned to the wan patient and touched his hand. Take it easy, now. I know it hurts to breathe, but your oxygen level looks fine, so that’s a very good thing. The old man gave her a weak smile and closed his eyes.

Nah. The other guy was watching a doe and her fawn grazing in the woods, and he sort of forgot he was behind the wheel. He wasn’t hurt at all, of course.

The ranger took her under her arm and pulled her out of the room with him during the X-ray. Saving our gonads for the future, he quipped when they had moved out of range of the radiation. His sandy hair fell to his hazel eyes, flecks of green and brown like the forest, and his full lips curved into an appreciative smile as he looked at her, still holding her arm. His high cheekbones gave his face a Native American cast, and he smelled of leather and coffee. Abby was aware of his large hand encircling her upper arm, of his fingers in her armpit brushing the side of her chest along her breast.

Nice, he said, breathing the word out.

Excuse me?

Nice to meet you, Dr. Wilmore. I’m Jake Peterson.

Abby. She pulled out of his grip, stepped back. Thanks for helping with this patient.

Let’s see if the X-ray shows I guessed right.

Surprised, Abby saw Dr. John Pepper poke his head out of an exam room door and ask for Dolores. Someone must have called him because of the multiple traumas. He gave Abby a quick nod.

Nothing looks too serious, except maybe the guy you’re seeing, he remarked, glancing at Peterson and back to Abby. You need any help?

Thanks, just waiting for the X-ray. He’s stable enough, but I’m sure he’ll need to go to the hospital.

Tell Ginger up front, she’ll start the arrangements, Pepper said, disappearing back into the exam room.

The friendly pepper-upper, Jake murmured in a singsong way that made Abby want to laugh, but she quickly stifled herself. When the X-ray was processed, she brought it up on the computer in the tiny office, Jake crowding in to see. There it was, a small pneumothorax, just as he had suspected. No fractured ribs, fortunately. She studied the black space around the inner ribcage where the lung should have been, and with her fingertip she outlined the thin membrane of the partially collapsed lung, its normal cobwebby tissues condensed and opaque.

A small pneumothorax, but it’s definitely there, she said. "Nice