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Turning to her mother, he handed her the prescription and said, “I hear a loud murmur in Helen’s heart, a noise that shouldn’t be there. I’d like for her to see a specialist.”
The woman stared at the note in her hand. “Will this medicine make her better?”
“I believe so, but she needs to see a heart doctor. I’ll have Amber make an appointment. I believe Helen’s heart condition is making her cough worse.”
The mother nodded. Relieved, he looked to Amber. She said, “I’ll take care of it.”
He saw several more townspeople after that with assorted coughs and colds. Then two young Amish brothers came in with poison ivy from head to toe. Their mother explained her usual home remedy had failed to help.
He asked for her recipe and jotted it down. He then ordered a steroid shot for each of the boys. Afterward, he gave their mother a prescription for an ointment to be used twice a day, but encouraged her to continue her own treatment as well.
When they left, Amber remained in the room.
“Yes?” He kept writing on the chart without looking up.
“Why didn’t you have her discontinue her home remedy? It clearly isn’t working.”
“There was nothing in it that would interfere with the medication I prescribed. It should even give the boys some added relief. Mostly, it will make her feel better to be doing something for them.” He snapped the chart shut. “What’s next?”
His final patient of the day turned out to be an Amish woman with a badly swollen wrist.
Amber stood by the counter as Phillip pulled his chair up beside the young Mrs. Nissley. Her first name was Martha. She held her arm cradled across her stomach.
Phillip said, “May I see your wrist, please?”
Taking it gently, he palpated it, feeling for any obvious breaks. “Tell me what happened.”
“The dog scared my Milch cow, and she kicked. She missed the dog but hit me.”
He winced. “Sounds painful.”
“Ja. That it is.”
He admired her stoicism. “You’re the first cow-kick victim I’ve treated in my career. In spite of that, the only way to be certain it isn’t broken is to get an X-ray. Are you related to Edna Nissley?”
“Which Edna Nissley?”
He struggled to find a description since they dressed alike and seemed so similar. “She’s an older lady. Short, kind of stout. Oh, she drives a gray horse.”
“That is my husband’s uncle’s wife. The other Edna Nissley is the wife of my husband’s cousin William. Little Edna Nissley is the daughter of my husband’s youngest brother, Daniel.”
“Okay.” A confusing family history if he’d ever heard one. He glanced at Amber. “I’ll need AP and Lateral X-rays of the left wrist. Mrs. Nissley, is there any chance you may be pregnant?”
“Nee. At least, I don’t think so.”
He looked at Amber. “Make sure she wears a lead apron just in case.”
“Of course.”
Ten minutes later he had the films in hand. Putting them up on the light box, he indicated the wrist bones for his patient to see.
“I don’t detect a break. What you have is a bad sprain and some nasty bruising. I’ll wrap it with an elastic bandage to compress the swelling. Rest it and ice it. I want you to keep the arm elevated. Is there a problem with doing any of those things?”
“Can I milk the cow?”
He tried not to smile. “If you can do it with one hand or with your toes.”
She grinned. “I have children and a helpful husband.”
“Good. Here’s a prescription for some pain medication if you need it. See me again if it isn’t better by the end of the week.”
When Mrs. Nissley left he saw the waiting room was finally empty. A glance at his watch told him it was nearly four in the afternoon. More tired than he cared to admit, Phillip retreated to his grandfather’s office and sank gratefully into Harold’s padded, brown leather chair. If his seventy-five-year-old grandfather kept this kind of pace, he was hardier than Phillip gave him credit for.
After only five minutes of downtime, a knock sounded at his door. Sighing, he called out, “Yes?”
Amber poked her head in. “I have a ham sandwich. Would you like to share?”
His stomach rumbled at the mention of food, reminding him he’d had nothing but one cup of coffee since he’d left the house that morning. “I’d love a sandwich. Thank you.”
She entered and whisked a plate from behind her back. “I thought you might say that.”
He took her offering and made a place for the paper dinnerware on his desk. “Why don’t you and Wilma join me?”
“Wilma has gone home.”
“Then will you join me?” He held his breath as he waited for her reply.
Amber hesitated. It was one thing to work with Phillip. It was a whole other thing to share a meal with him.
He said, “Don’t tell me you’ve never joined Harold for a late lunch.”
“Of course I have.”
“Then what’s the problem? Afraid I’ll bite or afraid you won’t be able to resist stabbing me with a knife?”
“All I have is a plastic fork, so you’re safe on that score.”
“Good.” He lifted the upper slice of bread and peered inside. “You didn’t lace this with an overdose of digoxin, did you?”
“And slow your heart until it stopped?” She snapped her fingers. “Wish I’d thought of it. Then Dr. Dog could take over. Thanks for the idea.”
Grinning, Amber left the room and returned to the break room to get her half of the sandwich. It seemed Dr. Phillip had a sense of humor. It was one more point in his favor. The most impressive thing about him, good looks aside, was how he dealt with patients.
During the long, exhausting day he had listened to them. He discussed his plans of care in simple terms. And he was great with children. She liked that about him.
He could be a good replacement for Harold. If only she could change his mind about her midwife services.
Looking heavenward, she said, “Please, Lord, heal Harold and send him back to us quickly. In the meantime, give me the right words to help Phillip see the need the Amish have for my work.”
With her plate in hand, she returned to his office. She saw he’d been busy clearing off another spot on the opposite side of the desk. She pulled over a chair and sat down. Closing her eyes, she took a deep breath then silently said a blessing over her meal.
“Sitting down feels good, doesn’t it?” Phillip asked.
She nodded. “You can say that again.”
“Is the clinic normally this busy?”
“We serve a large rural area besides the town. Today was busier than usual but not by much.”
He took a big bite of his sandwich. “This is good,” he mumbled with his mouth full.
“I picked it up at the café this morning.”
“Okay, I have to know. Why is it called the Shoofly Pie Café?”
“You’ve never heard of shoofly pie?”
“No.”
“Wait here.” Rising, Amber returned to the break room and pulled a small box from the bottom shelf. Returning to Phillip’s office, she set it in front of him with a pair of plastic forks.
He popped the last bite of sandwich into his mouth and cautiously raised the lid of the box. Swallowing, he said, “It looks like a wedge of coffee cake.”
“It’s similar. No dessert in the world says ‘Amish’ like shoofly pie. It’s made with molasses, which some people say gave it the name because they had to shoo the flies away from it. It’s a traditional Pennsylvania Dutch recipe but it’s served in many places across the South.”
“Interesting.”
“Try some.” She pushed it closer.
He shook his head.
“Are you a culinary chicken, Dr. Phillip?”
“It must be loaded with calories. I don’t indulge in risky behaviors.”
“That from a man who surfs the North Shore of Oahu?”
His eyes brightened. “You follow surfing?”
“A little.” And only since Harold told her it was his grandson’s favorite sport.
Phillip sat back and closed his eyes. “The North Shore is perfection. You should see the waves that come in there. Towering blue-green walls of water curling over and crashing with such a roar. The sandy shore is a pale strip between the blue sea and lush tropical palms. It’s like no place else on earth.”
“I’d like to see the ocean someday,” she said wistfully.
His eyes shot open in disbelief. “You’ve never been to the seashore?”
“I once saw Lake Erie.”
“Sorry, that doesn’t count. What makes you stick so close to these cornfields?” He picked up the fork and tried a sample of pie.
“I was born and raised in Ohio.”
“That’s no excuse.” He pointed to the box with his fork. “This is good stuff.”
“Told you. I was raised on a farm in an Amish community about fifty miles from here. My mother grew up Amish but didn’t join the church because she fell in love with my father, who wasn’t Amish. They owned a dairy farm. That means work three hundred sixty-five days a year. I don’t think I traveled more than thirty miles from our farm until I was in college.”
“What made you go into midwifery?”
“I always wanted to be a nurse. I liked the idea of helping sick people. Becoming a CNM wasn’t my first choice. I was led to become a nurse-midwife by my older sister, Esther. You would have liked her.”
Thoughts of Esther, always laughing, always smiling, brought a catch to Amber’s voice. He noticed.
“Did something happen to her?” he asked gently.
“Unlike mother, Esther longed to join the Amish church. She did when she was eighteen. After that, she married the farmer who lived across the road from us.”
“Sounds like you had a close-knit family.”
“Yes, we did. Esther had her first child at home with an Amish midwife. Everything was fine. Things went terribly wrong with her second baby. The midwife hesitated getting Esther to a hospital for fear of repercussions. By the time they did get help, it was too late. Esther and her baby died.”
“I don’t understand. How would that make you want to become a midwife?”
“Because a CNM has the skills, training and equipment to deal with emergencies. There are a lot of good lay midwives out there, but as a CNM I don’t have to be afraid to take a patient to the hospital for fear of being arrested for practicing medicine without a license. I can save the lives of women like my sister who want to give birth at home because they truly believe it is the way God intended.”
“Had your sister been in the hospital to start with, things might have turned out differently.”
He didn’t get it. She shouldn’t have expected him to. “Maybe, or maybe God allowed Esther to show me my true vocation among her people.”
Amber helped herself to the small bite of pie he’d left. “My turn to ask a question.”
“Why won’t I allow you to do home deliveries? I don’t believe it’s safe.”
She leaned forward earnestly. “But it is. Home births with a qualified attendant are safe for healthy, low-risk women. Countries where there are large numbers of home births have fewer complications and fewer deaths than here in the United States. How do you explain that if home births aren’t safe?”
“The American College of Obstetricians and Gynecologists do not support programs that advocate home birth. They don’t support individuals who provide home births.”
“Is that for safety reasons or financial ones? I’m taking money out of their pockets if my patients deliver at home.”
“You think the majority of doctors in the ACOG put money before the safety of patients? I doubt it. We could argue this point until we’re both blue in the face. I’m not changing my mind.”
Frustrated, Amber threw up her hands and shook her head. “This isn’t a whim or a craze. This has been their way of life for hundreds of years. At least listen to some of the Amish women who want home births. Hear their side of the story. This is important to them.”
All trace of humor vanished from his face. “What part of no don’t you understand, Miss Bradley?”
They glared at each other, the tension thick enough to cut with a knife.
Suddenly, Amber heard the front door of the clinic open. A boy’s voice yelled, “Doktor, doktor, komm shnell!”
She leapt to her feet. “He says come quick.”
Chapter Five
Phillip jumped to his feet and followed Amber out to the office lobby. An Amish boy of about eight began talking rapidly. Phillip couldn’t understand a word. He looked at Amber. “What’s he saying?”
She shushed him with one hand until the boy was done. Then she said, “Their wagon tipped over in a ditch. His mother is trapped.”
“Did he call 9-1-1?”
She gave him a look of pure exasperation. “How many times do I have to tell you? They don’t have phones.”
Running back to his office, Phillip grabbed his grandfather’s black bag from a shelf beside the door. Returning to the lobby, he saw Amber had a large canvas bag slung over her shoulder.
He said, “I’ll get the car. Try to find out from him how badly she’s hurt and where they’re located so we can get EMS on the way.”
Taking the boy by the hand, Amber followed Phillip out the door and climbed into his black SUV. She said, “It’s Martha Nissley, the woman we treated today. They overturned near their farm. It’s a quarter of a mile from the edge of town. Should I drive?”
“You navigate and try to keep the boy calm. Is he hurt?”
She spoke briefly to the boy in Pennsylvania Dutch. He shook his head. To Phillip, she said, “I don’t think so. He’s just out of breath from running and from fright. Turn left up ahead and then take the right fork in the road.”
Phillip did as instructed. He wanted to hurry but he knew he had to drive safely. He’d heard horror stories from his grandfather about buggy and automobile collisions on the narrow, hilly roads.
“There, that’s the lane.” Amber pointed it out to him as she was dialing 9-1-1 on her cell phone.
Topping a rise, Phillip saw a group of four men freeing the horses from the wagon. Both animals were limping badly. The wagon lay on its side in a shallow ditch. Phillip pulled to a stop a few yards away.
Turning to Amber, he said, “Make the boy understand he needs to stay in the car.”
“Of course.” After giving the child his instructions, Phillip and Amber got out.
Martha was lying facedown in the ditch, trapped beneath the wagon. A man knelt beside her. Phillip assumed he was her husband.
Only the broken spokes of the front wheel were keeping the wagon from crushing her completely. The rear wheel bowed out dangerously. If either wheel came off, she wouldn’t stand a chance.
He knelt beside her. “Martha, can you hear me?”
“Ja,” she answered through gritted teeth.
“Where are you hurt?”
“My back burns like fire. I can’t move my legs.”
His heart sank. “All right, lie still. We’ll get you out.”
“Where is my boy, Louis? Is he okay?”
“He’s sitting in my car. I told him to stay there.”
“Goot.” She began muttering what he thought was a prayer. Amber scrambled down in the ditch beside them. Quickly, she checked Martha’s vital signs. Then, to Phillip’s horror, she lay down and wiggled as far under the overturned wagon as she could.
After a minute, Amber worked herself backward and Phillip helped her gain her feet. He said, “Don’t do that again.”
“Martha’s bleeding profusely from a gash on her left thigh. I couldn’t reach it to put pressure on it, but it’s bad.”
He wanted to wait for the fire department and EMS. They’d likely have the Jaws of Life to lift the vehicle. But if she were hemorrhaging as badly as Amber thought, time was of the essence. “Okay, we’ll have to get the wagon off of her.”
Phillip turned to the men gathered around. The one kneeling beside Martha rose and joined them. “I’m David Nissley, Martha’s husband. We were afraid to move the wagon and do Martha more injury.”
“You were right. However, we need to move it now.”
Mr. Nissley pointed up the lane. “My boy, Noah, is coming with the draft team.”
What Phillip wouldn’t give for a forklift or at least a tractor…something he knew had enough power and wouldn’t bolt in fright and pull the heavy wagon on top of his patient. He considered trying to use his SUV but there was no room to maneuver on the narrow road.
He said, “We need some way to brace the wagon in case that wheel comes off.”
“We can use boards from there.” Amber pointed to the white painted fence running alongside the road. An instant later, Mr. Nissley and the men were dismantling the boards by using their heavy boots to kick them loose from the posts.
Phillip watched the activity impatiently. “Once we have it braced so it can’t fall back, we’ll try pulling it off her.”
A boy of about fifteen came racing down the road with a pair of enormous gray horses trotting at his heels. Sunlight gleamed off their shiny flanks as their powerful muscles rippled beneath their hides. They made a breathtaking sight.
The boy quickly backed them into position. They stood perfectly still as they waited for their harnesses to be hooked to the wagon. Feeling dwarfed by the massive animals, Phillip decided a tractor wouldn’t be necessary.
He turned back to Mrs. Nissley just as Amber was once again working herself under the broken vehicle, this time with her bag. He caught her foot. “What do you think you’re doing?”
Her voice was muffled. “Once the weight comes off her leg, someone has to put pressure on that gash. It’s oozing bright red blood.”
“You think it’s a severed artery?”
“I do.”
He didn’t like the danger she was putting herself in. He let go of her ankle because he knew she was right. The weight of the wagon on Martha might be stemming the flow of blood. Once it came off, she could bleed out rapidly.
Mr. Nissley alternated between speaking comforting words to his wife, directing the men making braces and instructing his son on the best way to attach the horses to the rig.
In less than five minutes, they were ready. Mr. Nissley spoke briefly to his wife, then took the reins from his son.
The boy said, “I can do it, Papa?”
“Nee, das ist für mich zu tun.”
Phillip looked at Mrs. Nissley for an explanation. “He said, ‘This is for me to do.’ If it falls back, he doesn’t want my son blaming himself.”
Another man called the boy over to help with the braces. Mr. Nissley coaxed the big horses forward. The wagon creaked ominously but lifted a few inches. The men standing by instantly moved in with the fence boards to prop it up. Squatting beside Amber’s feet, Phillip prepared to drag her out of harm’s way if need be.
The wagon inched upward with painful slowness, but finally Martha was free. Amber was already staunching the flow of blood with a heavy pad as the team dragged the broken wagon across the road. Phillip rushed to help secure the pad with a heavy elastic bandage. Amber was right. It was arterial blood. Martha would have bled to death if they’d delayed any longer.
The Amish woman was conscious but pale. Phillip said to Amber, “What supplies have you got in your bag?”
“IV supplies, pain medication, sterile drapes, suture, anything you’d need for a regular delivery. I’m going to start an eighteen gauge IV with Ringer’s Lactate.”
“Once that’s done give her a bolus of morphine if you’ve got it. Martha, are you allergic to any medications?” “Nee.”
All color was gone from her cheeks and her breathing was shallow. Phillip’s concern spiked. She was going into shock.
“Amber, hurry with that IV.”
“Should we try and turn her over?” Amber asked as she rapidly assembled her equipment, donned gloves and started prepping Martha’s arm for the needle.
“I’d rather wait for EMS and their backboard.” Phillip grabbed his stethoscope from his bag and listened to Martha’s lungs through her back. They were clear of fluid. One thing in her favor.
Amber slipped the IV line in and started the fluids. Gesturing to one of the men nearby, she gave him the bag to hold.
After handing over the reins of his horses to his son, Mr. Nissley returned to his wife’s side. Once there, he sat beside her and simply held her hand without saying a word.
Relief ripped through Phillip when he heard the sound of a siren in the distance.
Within minutes, the ambulance arrived on the scene, followed by a sheriff’s department cruiser. Standing beside Amber, Phillip felt her grasp his hand as they loaded Mrs. Nissley aboard.
Louis jumped out of Phillip’s SUV and raced to his mother’s side. She patted his head and told him not to worry. One of his sisters took his hand and coaxed him away. Mr. Nissley climbed in beside Martha. Soon they were on their way to the hospital in Millersburg, red lights flashing.
Together, Phillip and Amber watched the vehicle disappear in the distance. As the adrenaline drained away, Phillip grew shaky. Looking down, he noticed Amber still gripped his hand.
Following Phillip’s gaze, Amber realized her fingers were entwined with his. Suddenly, she became aware of the warmth traveling up her arm from where they touched. It spread through her body in waves and made her skin tingle like a charge of static electricity.
Their eyes met. An intense awareness rippled around them. Her breath froze in her chest. Her eyes roved over his face, soaking in every detail and committing it to memory.
Sweat trickled down his cheek. His hair was mussed, his clothes dirty. None of that diminished the attraction drawing her to him.
Behind her, someone spoke and a discussion about where to take the wagon broke out. She let go of Phillip’s hand and wrapped her arms across her chest. It had to be the adrenaline ebb. Holding his hand surely wasn’t making her weak in the knees, right?
He said, “I should follow them to the hospital. She’s my patient, after all.”
Amber struggled to get herself together. “We’ll need to make arrangements for the family to travel there, too.”
Phillip reached into his pocket and pulled out his cell phone. “Who shall I call?”
“Samson Carter has a van service.” She gave him the number and after someone answered, he handed the phone to the oldest Nissley boy. When the boy was finished with the call, he handed the phone back and then gave instructions to his younger brothers and sisters. Already, the neighbors who had come to help were busy repairing the fence. The sheriff was interviewing them.
“Will these kids be all right?” Phillip asked quietly as they made their way toward his SUV.
Walking beside him, Amber nodded. “Yes. Word will spread quickly, and they will be smothered with help. Men will come to do the chores and women will come to take charge of the house. An Amish family never has to worry about what will happen to them in an emergency. It’s a given that everyone in the Church will rally around them.”
“That’s good to know. Martha shouldn’t have been driving that big wagon with her arm in a splint.”
“She wasn’t driving. Her son was.”
“That little one who ran to our clinic?”
“Yes, but it wasn’t his fault. Some teenage boys driving by in a pickup threw firecrackers under the wagon and spooked the horses.”
He stopped. “Does the officer know that?”
Amber glanced over her shoulder. “I doubt it. They won’t talk to the authorities about it. They will forgive whoever has done this. It is their way.”
“Someone should tell the officer. Can you get a description of the vehicle from them?”
“No. They won’t talk to me about it. I’m an outsider, like you.”
“But you’ve lived here for years.”
“That makes no difference. I’m not Amish.”
The sheriff came over to them. Tall and blond, with eyes only a shade lighter than Amber’s, he smiled at her fondly. “Hey, cuz. Can you give me any information about what happened here?”
“Hi, Nick. I can tell you what I overheard but not much else.” She relayed her story while he took notes.
After a few minutes, he put his notepad away. “Thanks. Not much chance of solving this but I’ll give it my best shot. How about you, Doc? Can you add anything?”