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He stood hard and unyielding, one arm stretched across the entry as if to block Kayla's approach. Light spilled from the angled door of the old farmhouse, warming the mold-hashed porch with a splash of gold, backlighting his rugged frame.
Disadvantaged, Kayla stopped, wind-driven snow chilling her legs despite her well-fitted Ann Taylor pants. Note to self: If clients leave you in the snow, spend the bucks and buy some of those cute, girly, long underwear. Soon.
The broad-shouldered man remained shadowed, while lamplight bathed her approach. Well. She'd seen this often enough. The word hospice scared people, especially at first. With a small nod, she extended her hand. "Kayla Doherty, Visiting Nurse Service."
Eyes tipped down, he didn't give way, just stood for long seconds, contemplating her hand. Then he moved back, allowing her to enter while ignoring her gesture.
Kayla stepped into coffee-scented air. She breathed deep, wishing she'd had time for a caffeine fix, but weather reports had spurred her to this farm before conditions worsened. Sniffing the air with appreciation, she stood in a sparse but clean entry. The kitchen lay ahead, while a stairway hugged the wall to her left. A throw rug took up one corner of the polished hardwood floor.
Various footwear stood along the colorful weave. Reading the silent message, she placed her bargain-basement-priced short-boot Sudinis next to taller, hardier boots. Setting down her tote, she slipped into jeweled, open-toed clogs. She'd tricked-out the shoes herself, using a flashy array of sequins and beads. Her older female patients loved the effect. Fun shoes became an easy conversation starter, and often jogged memories of easier times. She hoped so.
The deep, masculine voice showed disbelief and…scorn? Sure sounded like it.
Kayla didn't try to examine the vibes as she eyed rugged work boots and their tall, rubber companions. Proper barn wear for a man of the fields, a person who faced the prolonged winters of St. Lawrence County, New York, on a personal level. She assumed a look of patience and straightened, facing a good-looking man about her age, his features dimmed by shadows of anger and death, a formidable combination. "They're comfortable for working with patients, Mr.…DeHollander?" She ended on an up-note, making the statement a question, hoping he'd introduce himself.
She'd heard of Marc DeHollander. Women loved to talk about men, and the gals comprising the medical community of greater Potsdam were no exception. The rumor mill labeled Marc total eye candy, with a great personality.
Well. One out of two ain't bad.
She'd dated one of Marc's friends several years back, but Marc had never crossed her path. This man was the right age, but the taciturn expression didn't fit the image. Imminent death had a way of changing a person. Kayla understood that. He'd probably lighten up as time went on.
He glared at the outside thermometer through semi-frosted glass. "Six degrees. Wind chill's at least twenty below. Who wears foolish shoes like that in the dead of winter?"
Kayla scratched her whole "lighten up" theory. Some clients were just downright ornery, regardless. Marc DeHollander's name just got tucked under the heading "resident jerk." She
ignored his negativity and swept the small room a glance. "Warm enough in here."
"It's comfortable for Dad." Face taut, he headed into the kitchen. Kayla followed as he tugged the collar of a black tur-tleneck layered beneath a green plaid flannel. The inside temperature was a little much for his mode of dress.
Kayla understood. End-stage patients often suffered effects of temperature. Extremities chilled, causing discomfort. She glanced around the kitchen.
The room lay spare, like the entry, but neat other than some breakfast clutter. Old-style, glass-fronted cabinets marched in formation around the upper level, offset by wood-fronted, thicker partners below. The cupboards wore a soft shade of green, faded with time. A chipped but uncluttered laminate counter met a backsplash of ivory tile. The effect appeared old and utilitarian, but cared for.
A man's house.
Kayla glanced up at the disgruntled man nearby. A big guy, about six feet and one-eighty, she wondered if he meant to intimidate her. If so, he was doing a good job. She hoisted her work case, determined to make nice. "Would you like to talk first, or introduce me to your father?"
His facial shadows deepened. A muscle in his right cheek twitched. He worked his jaw, then grimaced. "Dad's through here."
Thank you, Mr. Congeniality. Kayla followed him through a dining room into a small bedroom beyond.
A hospital bed dominated the space. The patient opened his eyes as they approached. His look darted, confused. Sighing, he settled into the pillow.
Dreaming, Kayla decided. Normal sleep or drug-induced, she couldn't quite tell, but the startle-awake reflex was not unlike a newborn. Cradle to grave, full circle.
"Your nurse is here." The son's tone left no doubt she wasn't here by his grace.
Kayla bit back a smart remark and focused on the sick man. She approached the right side of his bed, cheerful. "Mr. DeHollander?"
He nodded. His eyes cleared somewhat. "Yes."
She broadened her smile. "I'm Kayla Doherty from Visiting Nurse Service. Dr. Pentrow requested our services. Did he explain that to you?"
The older man glanced Marc's way. "He told us, didn't he, Marc?"
Gone was the look of antagonism that greeted Kayla's arrival. Marc leaned down and brushed a thin lock from his father's brow, his big hands gentle against his father's pale skin. "He did. And a home health aide to help out."
"Having people come to the house could get expensive." The dying man sent a look of concern his son's way. The bottom line had obviously ruled his decision making a long time, a concept Kayla comprehended.
"Your insurance covers both, Mr. DeHollander."
"Does it?" His frown deepened, trying to reason things out.
"Have you had pills this morning?" Kayla inquired. She angled her head and waited for his response.
"Yes," Marc answered, but didn't meet her eye. "Around five-thirty. I gave him two of these." He reached across his father's bed to hand her a bottle.
"You started this yesterday?"
Mr. DeHollander frowned.
Marc nodded. "I picked it up around four when I went into town to get my sister," he explained. This time he looked at her. "Is it the right stuff?"
"Yes," she confirmed. "It's ahydrocodone and acetaminophen mix," she continued, including both men in her explanation. Successful hospice care meant developing a strong working relationship with the caregivers and the patient. At some point the patient would likely lose the ability to participate in his/her own care. A satisfying hospice experience blossomed from establishing good rapport all around.
Kayla was good at working both sides of the bed, and that made her an effective hospice nurse, a fact she'd realized during her first years in the North Country. One of her hospital patients had brought her to faith, to hope, and eventually to her present gig.
She raised the container. "Effective for moderate pain. Side effects generally ease after a few days."
"Side effects like…?" Marc's look sharpened. He glanced at his father, then back to her.
Kayla addressed her patient. "Sleepiness. Confusion. Dreams."
Her listrelaxed Pete DeHollander's features. "All of the above."
Glad to have relieved his mind, Kayla offered a proposal. "Since you just started this, I'd like to see if the side effects level out. They usually do as the body acclimates. Can we try that, Mr. DeHollander?" She posed the question with a look of inquiry. "I don't want you to think this is an automatic trade-off. Less pain for a state of confusion. We have lots of things at our disposal. Your care will be based on what works for you. Adjustments in meds are common."
He contemplated her words, then looked at Marc. "I'm not thinking too clear," he admitted. He fiddled with the uppermost blanket, nervous. "What do you think?"
Kayla met Marc's eyes across the bed. She read the look in them. His expression offered resignation and little else. He'd do what he had to do, but it was plain he didn't like the choices. Whether his unease stemmed from the question or the situation, she had no idea. His gaze narrowed. "If we keep Dad on this medicine, the side effects might clear up?"
"Yes. If they don't, I'll call the doctor and we'll modify the meds. Our goal is to provide sufficient pain relief with minimal side effects."
"And it can be done?"
She scrunched her face and offered Marc a firm nod. "Absolutely." She hoisted her tote onto a side table. "I have an amazing bag of tricks, gentlemen."
The old man smiled. When he did, his gray-green eyes sparked with life. For just a moment, Kayla envisioned the man he'd been before his long battle with cancer.
Her throat tightened. She controlled the impulse to sympathize too much by dragging a chair alongside the bed. "You boys could at least ask a girl to sit down."
The old man looked affronted by his carelessness. "I don't know where our manners have gone," he exclaimed, surprised.
Marc's look hardened. He kept his eyes trained on Kayla, studying her. Fighting the rise of negative emotion, she addressed them both. "We should talk. I want you to know what to expect of me, what kind of care I'll be giving and what choices you have."
"Do those choices include a nurse who isn't afraid to get dirty and knows enough to wear sensible shoes midwinter?" Condescending, Marc swept her pert, polished nails and well-fitted blazer a look of disdain, his expression intimating she didn't have enough muscle to get the job done.
Ouch. The young farmer's cutting appraisal hit home. Striving to remember why peaceful conflict resolution was a good thing, Kayla faked a look of calm. She'd dealt with antagonistic families before. His anger wasn't all that unusual. Death managed to bring out the best in some people, but that wasn't a universal reaction.
She kept her voice confident, but didn't negate the hint of challenge in her reply. "We have a group of hospice nurses, male and female. We work individually, concentrating on specific cases. But—" she added, strengthening the note of reassurance "—someone is always on call so there's no lapse in service." She addressed her words to the older DeHollander. "If your nurse is off or away, you'll still have help regardless of the day or the hour."
"Makes sense," the older man agreed, his expression serious but accepting.
"Of course you can request a different nurse," Kayla continued. Her gaze encompassed father and son. "That's not a problem, because your nurse acts as your case coordinator, overseeing all aspects of your care." She turned and met Marc's eyes, unflinching. "Facing the loss of a loved one is difficult enough without personality clashes making it worse. Our job is to make things easier for you, Mr. DeHollander." She shook her head. "Not rougher."
Pete struggled more upright. "Why would we want someone different?" He glanced from one to the other before his gaze settled on Marc. His voice lost the fog of confusion. "What's going on?"
Marc squared his shoulders, eyes narrowed. "Nothing, Dad. I just want to make sure your treatment is taken seriously, every step of the way."
Kayla stared him down. He didn't squirm. She lifted her left brow. "Laughter is the best medicine. Haven't you heard?" Deliberately slow, she winked at the older man. "It aids in pain reduction, increased glucose tolerance, emotional bonding and vascular function." She gave Pete a perky shrug and a smile. "All for the price of a belly laugh. Fairly cheap, I would say."
"The price is right, sure enough." Pete grinned back at her, restoring the twinkle in his eyes. The smile made him look more vibrant, more alive.
Marc's expression noted that. His look softened. He reached out a hand to his dad's head in a gesture of comfort. "I've got to take care of some things in the barn. My cell phone's on." He patted his side clip. "Call if you need anything."
"I will," Pete promised. "Sorry about that business last night."
Marc frowned. "You remember that?" At his father's look of surprise, he added, "You were pretty confused, Dad."
"I'm not dead yet," the older man retorted.
"But definitely incapacitated," Kayla inserted. She kept her tone helpful and amused.
Pete DeHollander joined the game with a look Kayla's way. "Under the weather."
"Down, but not out."
"Rounding third and heading for home."
"And the crowd goes wild." Kayla raised her arms and widened her smile.
Marc stood, glowering. "I'm glad you two find this so—" Face tight, he drew a sharp breath, his jaw rigid. "Whatever. Some of us have work to do."
He strode out, his footfall decisive against the wide-planked floor.
Kayla watched him go with regret. She'd hoped a little humor might lighten him up, but no. She'd only angered him. Obviously the tact and diplomacy she'd been praying for needed fine-tuning.
Fine tuning? Her conscience prodded. How about major structural repairs? Run after him, Doherty. Maybe the guy's got a paper cut. You can apply a salt-water rinse followed by a splash of fresh lemon. Really make his day. Kayla sucked a breath and sighed.
"He'll be fine."
She turned back to Pete. "You think?"
Pete nodded. "Had a rough night. Lost a cow and a calf. She got bred in the wrong season and Marc didn't pick up on it. A lot going on, you know?"
Oh, Kayla knew. Doctor visits, hospitalizations, surgeries, tests, meds. All time consuming. And scary.
"By the time Marc realized she needed a C-section, it was too late."
"They died?" Kayla opened her laptop and stood to record Pete's vital signs. "They both died?"
"It happens." He shrugged. "Not often with Marc's cattle, though. He's got a good eye for line and crossbreeding. Hybrid vigor. He's made a nice business of it."
"Has he?" Kayla tried to shroud the doubt in her voice. From the looks of the farm buildings, Marc could use a lesson in painting, and dead cows didn't sound all that successful. And two at once? How sad.
"Farming's like life," Pete spouted, drawing himself up so she could examine him. "Full circle. Birth, death and everything in between."
"I guess." Kayla thought of the choices available in this day and age. Why would anyone farm?
She had no idea. Extremes of weather, fluctuations of market, never-ending days of slogging through muck and mud, snow and slush. What normal person chose that over climate-controlled nine-to-five, paid vacations, full benefits and a 401(k)?
Huh. She'd just answered her own question.
In her brief interlude with Marc DeHollander, she recognized normalcy as a relative feature. The father had it in abundance. Warm. Kind. Sociable, despite his illness.
The son was fresh out.
Marc finished loading the carcasses as his cell phone rang. He tugged off his gloves and fumbled the narrow instrument, his broad fingers awkward in the cold. "DeHollander."
"It's Stu," the truck driver reported. "I've finished at Brall's. I'm heading your way."
Marc worked his jaw, regretful. Last night's time glitch had cost him the life of a young cow and her calf, no small thing in the beef business. Even one as strong as his. "They're loaded. I'll wait for you at the end of the drive."