A Marriage In Wyoming

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Funny how the tone of the day could change so fast.

After replacing his hammer and the package of nails in his toolbox, Garrett climbed behind the wheel of his truck, intending to head toward the Circle M Ranch, where he and his brothers lived and worked. But just as he put his hand on the key to start the engine, he heard a door slam. He glanced at the clinic to find Rachel Vale hurrying down the walk. She opened the back of her SUV and pulled out a large duffel bag, then came up to his truck.

She opened the rear passenger door. “I just got a call from Caroline. There’s some kind of emergency at your place.” After slinging the duffel into the backseat, she climbed in the front. “We need to get out there right away.”

“Welcome to Bisons Creek,” Garrett said, pulling out into street. “I can’t tell you how glad I am that you’re here.”

* * *

“DID CAROLINE SAY what happened?” Garrett Marshall asked.

“Only that one of the kids was very sick,” Rachel told him. “I didn’t get any other details.”

After a short, mostly silent drive out of town, they turned in underneath the iron arch of the Circle M Ranch. Though her mind was preoccupied with the situation waiting for her, Rachel could appreciate the landscape of rolling, grassy plains and the big blue sky stretching overhead.

“A beautiful setting,” she said. “You must be proud of your property.”

“Not so much proud as grateful.” He smiled as he glanced over. “We feel pretty lucky to be able to take care of this parcel of land.”

Even though he’d said he was a minister, he certainly looked the part of the traditional rancher—close-fitting jeans, a dark blue work shirt and the quintessential white Western hat. With medium brown hair in a conservative cut and those sharp blue eyes, he made a very attractive cowboy, for those who found the type appealing.

Telling herself she wasn’t one of them, Rachel turned her gaze back to the view outside. “Has your family lived on the Circle M for generations?”

“No, as a matter of fact. My brothers and I lost both our parents before I was twelve. My oldest brother, Wyatt, was hired on here by Henry MacPherson, the man who owned the Circle M at that time. Eventually Henry had us all move out from town to live with him. When he died, he left the ranch to us. The Marshall brothers are relatively new to the ranching business, all told.”

She saw buildings in the distance—a timber-sided house and a big red barn on the hill above it. “Mr. MacPherson must have thought very highly of you.”

“Well, Wyatt is a responsible and dedicated worker—Henry knew he’d do his best for the place. The rest of us help out as much as we can, given our other responsibilities. Especially this summer, because Wyatt got bucked off a horse and broke a couple of bones in his back, so he’s out of commission for the time being.”

“That’s too bad. I hope he’s taking good care of himself.”

They approached the sprawling, single-story house, where a group of teenagers had gathered on the porch, most of them staring at their phones. Garrett stopped the truck in front of the steps. Before he’d even shifted into park, Rachel swung out of her seat, pulled the duffel from the rear seat, then crossed to the door and knocked.

Dark-haired Caroline Donnelly opened the screen door. “Oh, Rachel, I’m so glad you’re here. And so glad I could call you.” Behind her was a blond man who looked enough like Garrett that he had to be one of his brothers. Handsome evidently ran in the Marshall family.

Rachel gave her friend a one-armed hug. “Me, too. What’s going on?”

Across the room, a young girl lay bonelessly on the sofa.

“We were doing rodeo practice on the bucking barrel. Lena said she wanted to ride and walked over...but then she just sort of staggered and fell down. We carried her in and called an ambulance. And you.”

“Smart thinking.” Rachel knelt by the sofa. One deep breath of the fruity aroma surrounding the patient gave her all the information she needed. “Did she say anything?” From the front pocket of the duffel, she pulled out a glucometer to test Lena’s blood glucose level.

“She was acting kinda crazy this morning.” A tanned, black-haired boy sat in a recliner nearby. “I said she shouldn’t ride, but she wouldn’t listen.” His dark eyes were wide with fear. “Is she okay?”

Caroline came over and put a hand on his shoulder. “We’ve got help now, Justino. Dr. Vale will know what to do.”

“Did she eat breakfast?” Rachel asked. The blood-sugar result was high. And her blood pressure was low.

Justino shook his head. “She’s been sick for a couple of days. Throwing up and stuff.”

“Why didn’t she say something?” Garrett asked. “Why didn’t you?”

Rachel cut in. “She’s quite slender. Has she always been thin?”

“Yeah. But she said her jeans are getting loose, even though she’s been hungry a lot.”

“And thirsty?” Rachel asked.

“Oh, yeah. She drinks all the time.”

Lena fluttered her eyelashes and moved her head slightly.

“There you are,” Rachel said. “Hi, Lena, I’m Dr. Vale. How are you?”

“So thirsty,” Lena whispered without opening her eyes. “So tired.”

Turning again to her bag, Rachel began pulling out materials—an IV bag of saline and tubing, a syringe and a bottle of insulin. “Raise her legs,” she ordered over her shoulder. “Above her heart.”

While the others bustled around to help her, she handed the IV bag to Justino. “Hold this up high.” After inserting the needle into Lena’s arm, Rachel attached the tubing and adjusted the flow. Then she drew up ten units of insulin and injected it into the IV. “You’ll start to feel better soon,” she told the girl. Lena didn’t answer.

“That’s all I can do,” she said, getting to her feet. “She’s got to get to the hospital. How long ago did you call the ambulance?”

“They should be here any minute,” Caroline said. “What’s wrong? Why did she collapse?”

“She’s dehydrated and her blood glucose is very high. With fluids and insulin, though, she’ll start to improve.”

“Thank God,” Garrett said. “And thank you.” He glanced around the room. “These are my brothers, by the way. Ford’s the blond in the green shirt and Wyatt’s the one wearing the back brace.”

Nods were exchanged and hands shaken, but Rachel quickly returned her attention to Lena, noting that her breathing had slowed and her blood pressure had come up slightly. Positive signs.

Finally, she heard the siren they’d been waiting for. “The ambulance is here, Lena. You’ll be in the hospital in just a few more minutes.”

The vehicle stopped in the drive outside, lights flashing. Two emergency medical technicians came across the porch.

Rachel met them at the door. “I’m Dr. Vale, and this is Lena Smith.” She stood out of the way as one of the EMTs knelt by the couch, stethoscope in hand. “She’s in ketoacidosis. I started fluids and gave her ten units of insulin.”

The EMT nodded. “Got it.” The two men proceeded with their standard routine and, in only a few moments, had taken Lena out on a stretcher and put her into the ambulance.

“I want to come with her,” Justino said, following. “Please don’t make her go alone.”

The second EMT shook his head. “Not allowed. Sorry, son.”

The boy staggered, as if he’d been shoved.

Garrett put a hand on his thin shoulder. “You can come with me, Justino. I’ll follow the ambulance. Ford, could you call Lena’s dad to let him know what’s going on? Dr. Vale, I assume you want to come along, as well?” He ushered Rachel toward his truck.

“To begin with anyway. If Lena is part of this community, then I will be overseeing her care to some extent.” He opened the back door for her to stow the duffel on the bench, then held the front door so she could get in.

Once in the driver’s seat, he fastened his own belt and started the engine. “So today isn’t a onetime emergency?”

“I’m afraid not.” Rachel blew out a deep breath. “From all indications, this is a life-changing event.”

“What do you mean?”

“Lena will be under a doctor’s care for the rest of her life. She has juvenile-onset diabetes.”

* * *

THE TRUCK TOOK a sudden leap forward, then slowed as Garrett relaxed his foot. “She’ll be taking insulin shots?” He glanced at Justino in the rearview mirror. The teen was staring out the side window, lost in his own thoughts.

Rachel nodded. “Unless researchers find a cure. They’re always working on it.”

The prospect daunted him. “That’s a real challenge for a young girl.”

“The adults around her will have to help her cope. Are her parents going to be cooperative?”

“Her mother died last year. Since then, her dad has expected Lena to take care of her younger brothers and the house, as well as doing her schoolwork. She’s at the ranch because she’s been picked up for shoplifting several times in Buffalo and Kaycee and even Casper. She was cutting school with some of the older girls who can drive, and they’d spend the day out of town, getting into trouble. Caroline chose her for the camp, hoping it would turn her around so she could focus more on long-term goals.”

“Well, now she has the long-term goal of staying healthy to worry about.”

“I’ll pray for her to develop the strength she needs.”

“I’m sure that will help.” There was no mistaking the sarcasm in her voice.

He sent her a puzzled look. “Why do you say it like that?”

She blew out a breath. “Sorry. I didn’t mean to insult you.”

“I’m not insulted. But I want to understand your reaction. You don’t believe prayer can change events?”

“It might change the person who prays, because I believe in the power of the mind to affect behavior. But otherwise...no. Your prayer won’t call down some unseen power to help Lena deal with her diabetes.”

“You don’t believe in God?”

She didn’t answer for a minute. “I grew up going to church,” she said finally. “I can’t dismiss the possibility of a universal power. But as I observe life on this planet, I don’t detect much evidence of any kind of divine intervention. Good or bad, what happens, happens.”

There was silence as he drove the truck onto the highway exit ramp. “I’d be interested in talking more with you about that,” Garrett said, once they’d merged into traffic. “Meanwhile, we’ll have to work with Lena for the rest of the summer and get her started on the road to managing her condition.”

The doctor shook her head. “A summer ranch camp is probably not the best place for her to do that.”

Her opposition surprised him, but now wasn’t the time for a debate. “We’ll figure that out once she’s better.”

At the hospital, they pulled into the ER parking lot and went to the registration desk. Garrett showed the paperwork that granted him treatment permission, and they were allowed to join Lena in her cubicle. Justino went to the side of the bed and took hold of the girl’s free hand.

“That’s what you need,” Rachel said, nodding at the bag of fluid hanging near Lena’s head. “You’ll feel better soon.”

Lena rolled her head on the pillow. “I want to go back. To the ranch.”

Garrett faced her from the end of the bed. “We’ll take you as soon as the doctors say it’s okay,” he said.

“Lying around being sick at camp is no fun.”

People wearing scrubs came and went, asking the girl questions and drawing blood for tests. A nurse brought some food and urged Lena to eat a little. Finally, a man wearing a white coat over his scrubs entered the cubicle, a medical chart held in one hand.

He nodded at Garrett but then shifted his attention to Rachel. “Dr. Vale? I’m Brad Stevens, from the medicine service. I understand you’re the new doc down in Bisons Creek.”

She gave him one of those bright smiles. “I just pulled in to town today.”

“And ended up at work. That’s the way it goes, doesn’t it? Good call on the diagnosis.” Then he moved forward to stand beside the bed. “Hi, Lena. I’m Dr. Stevens. We’ve run some tests and I have some news.”

Lena opened her eyes to focus on his face. “What’s wrong?”

“You’ve haven’t been well for a few days, have you?” Lena shook her head. “Well, that’s because your blood glucose is very high.”

“I don’t understand.”

“Your cells use the glucose, or sugar, in the food you eat to produce energy and to function normally. There’s a chemical in your body called insulin, made by the pancreas, which helps release glucose into the cells so it can be used. But sometimes there’s not enough insulin. The glucose doesn’t get into the cells and instead stays in your blood. Your cells are starved and you become sick.”

“How do I get better?”

“We’re giving you insulin, and that will make a big difference.”

“Then I can leave?”

“Not right away. We want to watch you for a couple of days, ensure your system returns to a more normal state. And we have to talk about the changes you’ll need to make to manage your health. You see, Lena, your condition is known as diabetes. And you’ll have it for the rest of your life.”

Tears welled up in Lena’s big brown eyes and spilled over to run down her cheeks. “My mother had diabetes. She died.”

Rachel stepped up beside Dr. Stevens to put a hand on the blanket over Lena’s knee. “But that doesn’t have to happen, sweetie.” Her tone was gentle but reassuring. “You’re going to learn how to control your condition so you can be happy and healthy and live a long, wonderful life.”

“Can other people catch this diabetes from me?” Lena looked at Justino.

“Don’t worry, it’s not that kind of disease.” Dr. Stevens closed the chart. “First, we’re going to get you feeling better, then we’ll explain how you can keep yourself that way. I’ll talk with you again in a little while.” He left the cubicle.

A moment later, a nurse parted the curtains. “Lena’s father is here.”

Garrett led the way to the waiting room, where a Hispanic man in work clothes came toward them. “Lena is sick?” he said. “What’s wrong?”

“This is Dr. Vale,” Garrett told him. “She’s the new doctor in Bisons Creek and she can explain—”

“No, you are responsible for Lena,” Mr. Smith interrupted. “You explain.”

“Let’s sit down.” Garrett led the way to three chairs. “Lena has diabetes,” he said when they were seated. “Like your wife.”

Mr. Smith’s expression didn’t change. “She is going to die?”

“No,” Rachel said. “She can get treatment that will keep her alive for a long time. But she will have to take care of herself.”