CHAPTER 1
Katt let herself into the house and immediately turned on the TV. After finding the remote and turning to the right channel, she headed into the kitchen to pull together a snack. She had timed everything perfectly so that she had five minutes before her show came on. She danced around the kitchen, tossing her blond hair and sweeping her long arms out like a ballerina before deciding that was a bad idea if she didn’t want to risk smashing into something.
An apple, peanut butter, some milk because milk was important to build strong bones. If anyone needed to build strong bones, it was Katt. She pulled open the fridge and grabbed the big milk jug. It was full and it was heavy. Katt’s mind was already on her next movement, two steps over to the fruit bowl. She wasn’t thinking about bracing herself properly or pulling the milk jug out straight or about sliding one hand under it for extra stability. She just put her hand through the handle and jerked it off the shelf.
There was a loud pop in her shoulder and Katt yelped and let go of the milk jug. There wasn’t even time to swear as the jug fell and she realized that it was going to hit her foot. She was still reaching for her right shoulder with her left hand when the jug hit her foot. Katt gasped with pain.
“Ow, ow, ow!”
She hopped on her left foot, grabbing her injured right foot with her left hand while her right arm hung loosely at her side. Then she swore. Not again. How could she be so clumsy? The pain in her foot was worse than when she stubbed her toe on the iron frame of her bed. But she decided she’d better stop jumping up and down, or she was going to fall and break her tailbone too. Standing on one foot, she leaned against the central island of the kitchen, probing the bones of her right foot delicately. She was slender and her skin was so fair that the veins showed through the skin, and in the right light she could just about trace the bones beneath the skin without an x-ray. Almost without thinking of it, Katt transferred her grip to her right shoulder and eased the joint back into place with another loud pop. She rolled both shoulders and returned her attention to her foot.
The small bones in the top of her foot didn’t feel right. Unbelievable. It was like the boys at school said, all they had to do was look at Katt and she’d break a bone. Katt put her foot down, and balanced on the heel, not laying it flat on the floor. She bent down and used both hands to pick up the milk jug, which miraculously had not popped its top and hadn’t leaked a drop onto the floor. One less thing to worry about. She put it back into the fridge and opened the freezer to take out an ice pack. They were all arranged in the door of the freezer waiting for her.
Walking on her right heel, Katt minced through the kitchen, grabbing an apple from the fruit bowl, but abandoning her plans for peanut butter and milk. She settled herself carefully into the easy chair just as the opening notes of her show started to play on the TV.
Katt raised the footrest and carefully arranged the ice pack over her foot, settling back to watch her programs.
“I’m home,” Karina called out to Katt as she walked into the kitchen through the garage entrance and put her purse down on the counter. “How was your day?”
Karina rubbed her back with long, slender fingers as she went into the living room to greet her daughter. She instantly took in the ice pack on Katt’s foot.
“Uh-oh. What happened?”
Katt looked at her with luminous blue eyes. Her face was even paler and more angelic-looking than usual. Her wispy hair was tousled by the wind outside. Karina automatically gathered her own dark hair, pushing it behind her ears and back over her shoulders.
“I dropped the milk jug,” Katt said, apologetic.
“Anything broken?” Karina bent over Katt’s foot and pulled the now-warm ice pack away for a look. The foot was obviously swollen; the skin pulled tight. “Oh, damn.”
“I’m sorry, Mom. I didn’t mean to. I just wasn’t paying any attention when I picked it up…”
Karina returned the ice pack to the freezer and retrieved a cold one. She handed it to Katt to replace, knowing that Katt would tolerate the pain better if she were the one laying the ice pack over the injury. She went back to the garage and grabbed a pair of crutches, hardly even having to look to lay her hands on them. She took them over to where Katt was sitting.
Katt eyed the crutches and sighed. “Can we have dinner first?”
She was probably more concerned about watching the rest of her show than she was about eating, but it was a valid request. They both knew the menu in the hospital cafeteria sucked and that they would be waiting for at least a couple of hours before getting the foot set. They had to eat something at some point. It might as well be in the comfort of home.
“Fine, all right,” Karina agreed. “I’m just going to make mac and cheese. We’ll want to get over there before the evening rush.”
Katt looked at her watch and didn’t say anything. They were probably going to get there right in the middle of the evening rush, but Karina wanted to remain optimistic. Maybe there would be a lull, and they could get in and out in good time.
“How was school?” she asked, as she moved back into the kitchen to get started on cooking supper. “And how much homework do you have?”
CHAPTER 2
George Buckskin had already put in ten hours when he entered the curtained area where patient Katt Lindholm was sitting on a bed waiting. Like pretty much every other kid who went through the ER, she had a phone in front of her face while she texted, chatted, or played games to pass the time.
She was a lovely-looking girl, fifteen or so with blond hair, bright blue eyes, and pale, almost translucent skin. His skin was almost ebony compared to hers. When George walked in and picked up her chart, she set the phone down in her lap and gave him a tolerant smile. She’d already been there a couple of hours and was probably in considerable pain. But she and her mother, a brunette sitting beside the bed, didn’t jump all over him about the wait.
“So, it sounds like we’ve got a broken foot,” George offered, scanning the details on the chart. He lifted the ice pack off of her foot to take a quick glance at it, confirming that it was very swollen. Not much else he could do without x-rays. He could manipulate it, but with the amount of swelling, that would be excruciating and probably wouldn’t give him any answers. “What exactly did you do?”
Katt sighed and rolled her eyes. “I’m such a klutz,” she said, “I sort of… dropped a full jug of milk on it.”
George frowned, squinting at the notes that the nurses had made, which confirmed that she had told them the same story.
“And how did you do that?”
He proceeded to give her a quick exam, checking vital signs. The staff hadn’t bothered to hook her up to a monitor, so he took her pulse and blood pressure manually and listened for a moment to her chest. With the speed of her pulse and how high her blood pressure was, she was obviously in more pain than she was letting on with her calm, good-humored manner.
“Well, I just grabbed it out of the fridge,” Katt explained, making a brief motion, miming the movement. “But I wasn’t really paying attention to how heavy it was. My shoulder popped out, and I dropped it.”
“This shoulder?” He tapped her right shoulder lightly.
“Yes.”
George examined it, but could find no swelling or tender spots as he manipulated it.
“Is that something that has happened before?”
“Yeah. I kind of get hurt a lot. Some of my joints pop out more than they should.”
“So when you say it pops out, you mean it clicks? You get a little twinge of pain?”
“No,” Katt shook her head. “The joint pops right out.”
“And that doesn’t hurt?”
“Yes, it hurts. But when I pop it back in again—”
“How do you do that?”
Katt put her left hand over her shoulder and made an explanatory motion. “Just like that…”
“Hmm. Well, we need to get you down to x-ray to have a look at that foot. And I’d like to put you on a monitor so we can keep tabs on your blood pressure. You haven’t been given anything for the pain?” George picked up the clipboard again, scribbling his instructions and looking for any meds administered.
“No.”
“Do you have any drug allergies?”
“Uh-uh.”
“Have you had Demerol before?”
Katt nodded. “Yes. I don’t react to it.”
“Okay. Let’s get you some of that and down to x-ray.”
“Thank you,” Katt’s mother said. George had been ignoring her during the interview. Katt was old enough to answer his questions herself, and it was better not to have a third person filtering information and obscuring any signals.
“Mom, why don’t we have you go on back to the waiting room for now? Someone will come and get you when Katt is done in x-ray,” George suggested.
“Oh, I’ll stay with her.”
“You can’t go with her to x-ray. She’s a big girl; she’ll be okay. We’ll take good care of her. Why don’t you get yourself a magazine and a bite of supper from the cafeteria? It will be an hour before she’s done.”
“We already ate. I don’t need anything…”
George just looked at her, waiting. Eventually, she got the message that he wasn’t going to let her go down to x-ray with the teen. Her mouth a thin line, she stood up.
“I’ll see you in an hour, baby,” she told Katt, touching her on the arm, and then she headed back toward the waiting room.
George put the sides up on Katt’s bed to transport her. No point in her hobbling around on a broken foot or wasting time on a transfer from bed to wheelchair. It was easy enough to just transport her on the gurney.
“You have bruises on your legs,” he murmured to her, quiet even though her mom should have been well out of earshot.
“I have very fair skin and I’m a klutz,” Katt explained, as he put the clipboard down and started to push her. “I always have bruises.”
“Tell me again how you broke your foot.”
“I dropped the milk carton on it,” she said in an exasperated voice.
“Have you broken any bones before?”
“Yes. Arms, legs…”
“How?”
“I don’t know… I broke my ankle getting off of a trampoline. Tripped and fell and broke my wrist. Got knocked down playing hockey at school and broke my arm. I told you, I’m just clumsy.”
“Okay,” he agreed, not wanting to get her worked up, especially not with her blood pressure so high already.
Katt’s anxious expression smoothed. She nodded and relaxed, her eyes closing part way as he pushed her down the corridor and she watched the ceiling whip by overhead. George settled her in the x-ray intake waiting area and went to find a nurse to get Katt’s IV and monitor set up.
Marshall, the x-ray tech, stared down at the yellow requisition sheet that George had filled out. His brows drew down as he compared it to Katt’s chart.
“This is the girl with the broken foot, isn’t it?”
“Yes.”
“Then what is this?” Marshall flapped the yellow paper at him. “Why would we be doing full body x-rays on a kid who dropped something on her foot?”
“Follow me. I’ll show you.”
George led Marshall out of the x-ray room to where Katt was waiting.
“How’s that feeling now, Katt?” he asked, checking the drip on the IV.
“Lots better,” Katt said, her voice sleepy.
“Good. Your blood pressure is coming down. I just want to listen to your lungs, can you sit up for a minute?”
She swayed a little when she sat up, obviously woozy from the Demerol. George steadied her shoulder and placed his stethoscope on her chest over the hospital gown. Marshall was still looking at him like he was crazy. George switched the stethoscope to Katt’s back, pushing the gown to the side. As he rested the stethoscope on her back, not even bothering to listen to it, he looked at Marshall and then down at Katt’s bare back. Marshall got the hint and looked down. Katt’s white skin was discolored with several dark bruises. George avoided touching them as he moved the stethoscope around, instructing Katt to breathe. He withdrew the stethoscope and closed Katt’s gown.
“Great. Go ahead and lie back down. They’re just about ready for you.”
He walked with Marshall back into the x-ray room.
“Who’s been hitting her?” Marshall demanded.
“Mom or Dad, probably. You’ll do the whole thing?” George nodded to the requisition sheet still in Marshall’s hand.
“You bet. You putting in a call to Social Services?”
“Right now. I’ll have someone on it once you’ve got results for me.”
“Have you checked her history?” Marshall nodded to his own computer terminal.
George sighed. “Tell me you’d be surprised that she has multiple hospitalizations every year since she was born.”
“Yeah. They’ve never done anything?”
“No. Been investigated, but never any action. Which is why I want everything done and Social Services talking to the girl before the mother knows anything is going on. She can obviously sweet talk Social Services, and that’s not happening this time.”
“Bravo. I’ll be a while on this imaging. You should get her admitted in case the social worker doesn’t get here right away. Block her from going home immediately.”
“Good thinking. I’d like to keep her here for a bit anyway. Evaluate for soft tissue injuries.”
George left Katt in Marshall’s capable hands.
George managed to persuade Sarah Wolfe to join him to see Katt once she was finished in x-ray.
“Don’t you think you should wait for the results of the x-rays before calling Social Services?” Sarah suggested, irritable after having her growing pile of paperwork interrupted yet again.
“I don’t know what x-ray will show, but I know she has some pretty nasty looking bruises and a broken foot, and that she’s broken limbs several times before in accidents that sound a little suspicious.”
“A broken foot, that’s not usually abuse. You don’t see a lot of parents breaking their kid’s feet.”
“Maybe not. And maybe it wasn’t abuse this time, but looking at her… I have to believe she is being abused. That foot could have been broken by dropping something on it, or she could have been pushed and landed on it wrong. Or a piece of furniture could have been shoved over in a fight. Just because it’s not a twisted arm, that doesn’t mean it isn’t abuse.”
“No.” Sarah sniffed and didn’t argue it any further.
They didn’t go straight to Katt, but stopped at a computer terminal to take a look at the x-rays first. Marshall had been thorough. There were dozens of films, and a number of them already had markings and annotations on them. George started to go through them, translating the various points for Sarah who sat beside him looking at the screen.
“There’s her foot. Three bones broken. That’s pretty extensive for a ‘dropped something on my foot’ injury. You drop something on your foot, and you usually try to avoid it. Get a glancing blow. Maybe one small bone broken. Not several. Ankle on the same foot has been broken before. This is an old, healed injury. She said she broke it getting off a trampoline.”
“That could be true.”
“Yes. Could be. Moving up to the pelvis…” He traced a line on the x-ray. “There’s an old break here. Pelvic bones are big. It takes a lot of force to do this.”
“How would she break her pelvis?”
“Most likely a car accident. But I didn’t see anything on her record about a pelvic fracture. I don’t think it was ever treated.”
Sarah nodded, her expression stony. She was on his side now. She believed that Katt was being abused or at least neglected.
George swore, looking at films of Katt’s torso, especially the posterior views.
“What?”
“You see these rib fractures? One, two, three, four, five… and the vertebrae themselves. Old fractures here, here, here, and here.”
Sarah’s eyes widened. “Five ribs and four vertebrae? And she was never in a car accident?”
“You can look at her record. She’s had a lot of ER visits, but not anything like that.”
Sarah shook her head, scribbling quickly in her notebook now. “What else?”
“Wrist, she says she fell down. Radius and ulna, she said she was knocked down at school. Like I said, nothing that you would expect to cause these types of injuries. Oh, collarbone too. She didn’t mention that one. But it’s not like she would have forgotten.”
“Maybe it happened when she was very young? A baby?”
“No…” George studied it. “I don’t think it’s been that long since it healed. I wouldn’t put it over a year old.”
Sarah continued to write. “I’m glad you called me on this one. Sorry I gave you a hard time. Sometimes we get called and it’s just a simple case of bruised shins from playing sports…”
“I told you you would want to see her.”
“Yes. Let’s go have a little visit.”
It was late, and Katt was doped up on painkillers, so she was asleep when George and Sarah got to her bedside.
“Katt…” George nudged her. “Katt, I need you to wake up and talk to me for a few minutes.”
At first, she didn’t stir, then she jumped at his touch and her eyes went wide. She clutched at the sides of the gurney like she was afraid that she was going to fall out of it. George made a soothing humming sound.
“There, you’re okay,” he told her softly. “Calm down. You remember me? Doctor George.”
Katt nodded slowly. She looked around and rubbed her sleepy eyes. “Can I go home now?” she ventured.
“No, dear. I think we’re going to keep you here overnight. We’ll get your foot set and then we’ll find you a room for the night. Okay?”
“I don’t want to stay.” She yawned. “I want to sleep in my own bed. It’s just a broken bone; I don’t need to stay overnight.”
“We’re concerned about complications. It won’t hurt you to sleep here one night.”
Katt’s eyes fixed on Sarah. She shifted, propping herself up on her elbows. “Who are you?”
She probably had more than enough experience with hospitals and Social Services investigations to recognize a social worker when she saw one.
“Hi, Katt. I’m Sarah Wolfe.” Sarah extended her hand and Katt politely took it but didn’t shake. She just inserted her hand for a moment and then pulled back again.
“You’re not a doctor,” Katt said.
“No. I’m not. I’m just here to ask you a few questions about your injury and how things are going at home.”
“Things are fine at home.” Katt’s eyes went back and forth. “Where’s my mom? You said she could come back after I was done my x-rays.”
“She’ll be joining you again soon,” George assured her.
“Why don’t you tell me how you managed to break your foot?” Sarah encouraged, giving Katt a friendly smile. “I bet there’s a story there.”
“I dropped a milk jug on it,” Katt snapped. “I don’t know who you are, and I don’t want to talk to you.”
“I’m with Social Services, Katt. Was your mom at home when this accident happened?”
“No. I get off school before she gets off of work. But it was just my own clumsiness, and I was fine and safe there. I just waited until she got home. I knew it wasn’t an emergency.”
“So there wasn’t anyone at home with you?”
“No. But I’m fifteen. I don’t need a babysitter. I can take care of myself for an hour or two.”
“What about your dad? Was he at work too?”
“There is no dad. He abandoned my mom when I was born.”
Sarah nodded. “So it’s just you and your mom, huh? How do the two of you get along? Mothers and teenage daughters… things can get pretty intense sometimes, all those hormones.”
“We’re good friends. We get along.”
“Uh-huh.” Sarah nodded as if she believed it. “That’s nice. No boyfriend…?”
Katt’s skin flushed a little pink. “No, no,” she laughed. “No one is interested in me.”
“You’re a pretty girl; I find that hard to believe.”
“No. Guys aren’t interested. I’m not popular. I’m a klutz and everyone knows it. And… I’m just not one of the cheerleader types. I’m not… very good with people.”
“Do you play sports?”
Katt frowned, looking sideways at Sarah. “Why does that matter? I got hurt dropping something on my foot, not playing sports.”
“I just wondered. Sometimes you can get hurt playing sports and not realize how badly you hurt yourself. Or you can get bruises.”
“Oh, bruises.” Katt straightened the blanket over herself as if making sure that there were no bruises visible to Sarah. “I’m always covered with bruises. But that’s just because I bruise easily. Not because anyone’s hurting me. I don’t do sports because I’m clumsy, and I get hurt, even in gym class.” She shook her head. “I always have bruises, but they don’t mean anything.”
Sarah moved a chair closer to the bed and sat down, studying Katt. She moved up close like they were girlfriends gossiping together. She gave George a look that was clearly one of dismissal. He shrugged and moved away.
“Someone will be in to set that foot shortly.”
Sarah looked into Katt’s eyes. The girl was scared. Of course she was. She didn’t know who she could trust. She’d probably been told that if she said anything about her mother’s abuse, she’d get taken out of the home and terrible things would happen to her. There were always threats to keep children compliant. She wanted her mom there to answer the questions so that she wouldn’t have to expose herself.
“Katt… it’s more than just bruises, isn’t it?” Sarah said softly. “I know, some kids do bruise really easily. I remember when I was seven, my shins were always covered with bruises from kicking the boys at school! Sometimes I get bruises and I have no idea where they came from. But that’s not all that we’re talking about. You know that we took x-rays of your whole body, not just your foot.”
“Yes,” Katt agreed, her voice petulant. “I kept telling them that it was my foot and they kept saying they needed to x-ray other stuff as well. My mom is going to be really mad about exposing me to that much radiation. Radiation can make you sick. It can cause cancer later in life. We only get x-rays when we absolutely need to.”
“It wasn’t up to your mom. It was up to us to make sure that you are okay.”
“And now you know that I am.”
“Do you want to know what we found on the x-rays?”
Katt’s shoulders lifted and fell again. She didn’t answer aloud. Of course, she already knew what they had found on the x-rays.
“We found that you have had a lot of broken bones in your life.”
“I know. I told that to Doctor George. Stupid accidents. Not abuse.”
“You told him some of your injuries. Some of the times that you broke bones…”
“Yeah.”
“But not all of them.”
Katt’s mouth pursed, considering. She shifted around in the bed, looking for a comfortable position. Considering her injuries, there probably wasn’t a position that would be comfortable for her.
“I have a high pain tolerance,” she explained. “And with some kinds of breaks… there isn’t anything that the doctors can do. They can’t set them, all they can do is wait for them to heal.”
“You’ve had a number of broken ribs and vertebrae. Even pelvis, and that’s a big bone that’s hard to break.”
Katt didn’t say anything right away, smoothing the blanket over her body. “I don’t remember,” she said. “Some of them probably happened when I was too little to remember. That’s why I didn’t say. My mom could tell you and Doctor George about it.”
“When did you break your collarbone? George said that was in the last year.”
Katt frowned and ran her fingers along her clavicle. “I’m… not sure. I got hurt at school in September, some guy crashed into me in the hallway and smashed me against the lockers. It really hurt… Mom put my arm in a sling until it healed. I never thought it was broken.”
“That seems unlikely. You know what a broken bone feels like. And your mom just putting it in a sling and not taking you to the doctor is medical neglect.”
“My mom takes me to the doctor all the time!” Katt’s voice rose until she was almost yelling, her voice echoing off the hard tiles. “She’d never neglect me! That’s garbage! If I went to the hospital every time something hurt, I’d be here all the time. I don’t unless we know something is really wrong. If it’s just random pain from getting banged around, I stay home and ice it.”
Sarah wrote down a few more notes. She started a checklist at the side of her paper. Talk to the school. Talk to the family doctor. Review previous hospitalization records. Try to get the mom to identify how each broken bone occurred. Start making phone calls to find a long-term foster care home for Katt. She was fifteen now. If they were lucky, they might find someone who would take her until she aged out. Get a written opinion from George for the court file. Get affidavits from any other experts they could recruit.
Sarah looked over at Katt, who was watching her scribble her notes with wide eyes.
“I want my mom now,” Katt insisted.
“She’ll be here before long.”
Sarah would need to get an emergency hearing to confirm Social Services apprehending Katt as soon as possible. Before Mom had a chance to start getting doctors and experts on her side. The last thing they wanted was for Katt to end up back home in a day or two.
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