Chapter 2 - THE CAST
The drive to the hospital took twenty-three minutes.
Aunt Diane spent eighteen of them explaining why Noah could not be trusted.
She sat in the passenger seat because she had insisted that, as his guardian, she needed to be beside me.
Noah sat in the back with his injured leg stretched across the seat and both crutches tucked on the floor beneath his good foot.
I watched him in the rearview mirror whenever traffic slowed.
He watched the crutches.
Not the road.
Not me.
The crutches.
As if they might disappear again.
Diane kept talking.
“He exaggerates because attention works on him.”
I gripped the steering wheel.
“He has always been dramatic.”
Noah turned his face toward the window.
“He cried for an hour over a splinter when he was six.”
“He was six.”
“That is exactly what I mean.”
I glanced at her.
“You think being six made the splinter less real?”
She exhaled through her nose.
“You don’t understand discipline.”
“Apparently I don’t understand tying an injured child to patio furniture either.”
Noah looked down.
Diane stiffened.
“Do not say it like that.”
“How should I say it?”
“He was secured to a chair because he would not follow medical instructions.”
I almost laughed from disbelief.
“Which medical instruction told you to hide his crutches?”
“That was temporary.”
“Which instruction said he should prove he needed them by hopping to the door?”
“I never said that.”
Noah’s eyes lifted to the mirror.
I saw the instant he realized she was denying it.
His mouth opened.
I spoke first.
“We can discuss it at the hospital.”
Diane snapped her head toward me.
“There is nothing to discuss.”
“Good.”
I turned into the emergency department entrance.
“Then this should be quick.”
It was not quick.
At registration, Diane answered every question before Noah could finish breathing in.
Date of injury.
Mechanism of injury.
Pain level.
Medication schedule.
New symptoms.
She even tried to answer when the nurse asked Noah what grade he was in.
The nurse noticed.
Her name badge said KELLY, RN.
She had gray streaks in her hair and the kind of calm expression that made it obvious she had already seen three different kinds of disaster that day.
She looked at Diane.
“I’d like him to answer the questions that are about him.”
Diane smiled.
“Of course.”
Kelly turned back to Noah.
“Pain from zero to ten?”
Noah looked at Diane.
Kelly shifted her chair until she blocked his view of her.
“Look at me.”
Noah did.
“What number?”
“Seven.”
Diane made a sound behind Kelly.
Noah immediately changed it.
“Maybe five.”
Kelly did not write yet.
“What number before anyone else reacts?”
Noah swallowed.
“Seven.”
She wrote seven.
“Any numbness?”
“Sometimes.”
“When?”
“At night.”
“Both feet or the casted side?”
“The cast side.”
“Does anyone elevate your leg?”
Noah hesitated.
Diane leaned forward.
“I do.”
Kelly held up one finger without looking at her.
“Noah?”
“Sometimes I put it on a couch pillow.”
“Who gives you your medication?”
This time he did not look at Diane.
“I get the pills from the kitchen.”
My head turned.
“What pills?”
Diane answered.
“Children’s ibuprofen.”
Kelly’s expression remained neutral.
“Are they in a childproof container?”
Diane paused.
“Obviously.”
Noah shook his head.
“They’re in the little plastic cup.”
The room went very quiet.
Kelly set her pen down.
“What little plastic cup?”
“The blue one beside the microwave.”
“How many pills are in it?”
“Sometimes two.”
“Do you know the dosage?”
“No.”
“Do you know when you last took them?”
“Last night.”
Diane leaned in.
“He is making this sound much worse than it is.”
Kelly turned toward her.
“I need you to step into the hallway for a few minutes.”
Diane stared at her.
“I am his guardian.”
“Yes.”
“You cannot exclude me.”
“I can interview a pediatric patient privately.”
“I do not consent.”
Kelly stood.
The calmness did not leave her face.
“I’ll get the charge nurse.”
Diane looked at me.
“This is your fault.”
“No.”
I kept my voice low.
“This started before I arrived.”
The charge nurse came in with a security officer standing several feet behind her.
No one raised a voice.
No one needed to.
Diane finally walked into the hallway.
She pointed at me before the door closed.
“She is not his guardian either.”
Kelly nodded.
“I know.”
Then the door shut.
Noah stared at it.
His breathing changed again.
Kelly crouched so she was closer to his eye level.
“You are not in trouble.”
He nodded too quickly.
“I know.”
“You can tell me if someone told you that you would be in trouble for talking.”
He stopped nodding.
Kelly waited.
I wanted to fill the silence for him.
I did not.
Finally, Noah looked at me.
“Can Emily stay?”
Kelly glanced at me.
“If you want her to.”
“I do.”
He reached for my hand.
I sat beside him.
Kelly began with the cast.
“How did it get scraped?”
Noah told her about the chair.
He told her about the crutches being inside.
He told her about trying to hop to the door.
He told her he had fallen twice that afternoon.
I had only known about one fall.
The second had happened earlier, before I arrived.
“What happened the first time?” Kelly asked.
“I fell by the flowerpot.”
“Did you hit your head?”
“No.”
“Did your cast hit the ground?”
“Yes.”
“Why were you trying to get up?”
Noah rubbed his thumb over my knuckles.
“I had to use the bathroom.”
My throat tightened.
Kelly’s eyes shifted briefly to mine, then back to Noah.
“Why didn’t you call your aunt?”
“I did.”
“What did she say?”
Noah looked at the floor.
“She said I went an hour ago.”
I closed my eyes for one second.
Kelly did not react visibly.
“How long were you on the porch?”
Noah shrugged.
“I don’t know.”
“Was it before lunch?”
“Yes.”
“After breakfast?”
“Yes.”
“What time did Emily arrive?”
I answered.
“A little after four.”
Kelly’s pen paused.
She looked at Noah.
“Were you tied to the chair the whole time?”
Noah nodded.
My hand went cold around his.
I had assumed an hour.
Maybe two.
Not most of the day.
“Did you eat lunch?” Kelly asked.
“No.”
“Did you drink anything?”
“There was a water bottle.”
“Could you reach it?”
Noah shook his head.
I could suddenly see the porch again.
There had been a clear plastic bottle near the railing.
It had been maybe four feet from the chair.
Close enough to look like he had been given water.
Far enough that he could not touch it.
Kelly stood.
“I’m going to ask the physician to come in before we do anything else.”
Noah grabbed her sleeve lightly.
“There’s something else.”
She stopped.
“What?”
He looked at me.
I had never seen him look embarrassed by pain before.
“Under the cast.”
“What about it?”
“It burns.”
Kelly’s expression changed.
“Where?”
“Back of my heel.”
“How long?”
“Three days.”
“Did you tell anyone?”
He nodded.
“Who?”
“Aunt Diane.”
“What did she say?”
Noah stared at the door.
“She said casts are supposed to hurt.”
The physician came less than five minutes later.
He introduced himself as Dr. Patel.
He examined Noah’s toes, checked circulation, asked about sensation, and inspected the crack.
Then he ordered imaging and said the cast needed to come off.
Diane was allowed back in while they explained the procedure.
She objected immediately.
“You cannot just cut off a perfectly good cast because he complains about itching.”
Dr. Patel looked at her.
“He has altered sensation, increased pain, a damaged cast, and a report of focal burning at the heel.”
“He is dramatic.”
“That is not a diagnosis.”
Diane looked at me as if I had coached him to say it.
Noah tightened his grip on my hand.
The cast saw made a high mechanical buzz that made him flinch before it touched him.
I stayed beside his head while the technician cut along both sides.
The fiberglass shell loosened.
Then the padding came away.
Kelly inhaled sharply.
I looked down.
There was a raw pressure sore on the back of Noah’s heel.
Purple bruising spread around the lower leg.
And just above the ankle, the skin was swollen in a way I had not been able to see beneath the cast.
Dr. Patel stopped speaking.
Diane did too.
The room became silent except for the cast saw winding down.
Noah looked at me.
“I told her,” he whispered.
I squeezed his hand.
“I know.”
Dr. Patel studied the leg for several seconds.
Then he looked at Diane.
“When was his last orthopedic follow-up?”
She answered too fast.
“Three days ago.”
Dr. Patel turned to the computer.
“No, it wasn’t.”
Diane froze.
He clicked through Noah’s chart.
“His follow-up was scheduled for three days ago.”
He looked back at her.
“He did not attend.”
I felt my stomach drop.
Diane’s eyes moved toward the door.
Dr. Patel continued.
“And according to the clinic note, the appointment was canceled by the guardian forty-two minutes before check-in.”
Noah looked at her.
I did too.
Diane’s voice came out thin.
“I rescheduled.”
Dr. Patel looked at the chart again.
“No.”
He turned the screen slightly.
May you like
“You did not.”
