Excerpt of Silent Pledge by Hannah Alexander

The crunch of tires on gravel echoed across the unpaved parking lot as Dr. Mercy Richmond drove into the apartment complex where Odira Bagby lived with her great-granddaughter, Crystal Hollis. A bare lightbulb glowed over the small concrete front stoop at the door nearest the alley so she'd know which apartment was Odira's.

Mercy pulled as close to the steps as she could and reached over to turn up the heat in her car. The curtain at the window beside Odira's front door was open, revealing a front room with an old threadbare sofa and a straight-backed chair crammed into a ten-by-ten-foot space, along with an old TV resting on a nightstand. An off-white lace doily topped the TV. Mercy had never been here before, but she knew the sixty-six-year-old woman supported herself and seven-year-old Crystal on social security. She couldn't get a place at Sunrise Villa, the retirement apartments, because the new management didn't want children.

Before Mercy could shift the gear into Park, the front door opened and out lumbered Odira, all two hundred seventy pounds of her, with wraithlike Crystal beside her, bundled all the way to her nose in a thick quilt.

As Mercy stepped out of the car into the icy wind and hurried around to open the door for them, Crystal started coughing again—the same hoarse, dry sound Mercy had heard in the background when Odira called a few minutes ago. It was typical of a child sick with bronchitis, maybe even pneumonia, brought on by the specter of cystic fibrosis.

"Hope you didn't have to leave your own little girl at home alone for this," Odira said in her booming baritone voice that always seemed to shake the walls when she came to the clinic.

"No, I dropped Tedi off at my mom's on the way here." Mercy got Crystal and Odira settled in the car, slid into the driver's seat and pulled onto the quiet street for the five-minute drive to her clinic.

At the first stop sign, she noticed Odira sniffing…great, heaving sniffles. Tears, which she obviously could not contain, paraded down her cheeks. Odira was known to talk more than she breathed, a counterpoint to Crystal's silent watchfulness. But not tonight.

Mercy cast a second concerned glance at the woman, where the dash lights illumined her broad, heavy face and rusty-iron hair that looked as if it had been cut with a pair of dull scissors. Beside her, Crystal's face was thin and pale, filled with a sad knowledge. She raised her hand to cover her mouth when she coughed, just as Odira had taught her to. Her stout, clubbed fingers demonstrated the effects of oxygen deprivation to her extremities throughout her battle with CF.

"Are you two warm enough?" Mercy asked.

"I'm plenty warm." Odira looked down at Crystal and wrapped a thick arm around her. Worn patches at the sleeves of her thirty-year-old coat had been carefully mended. "You okay?"

Crystal nodded and ducked her head into her great-grandmother's side.

"What's Crystal's temperature?" Mercy hadn't bothered to inquire about that over the phone because she knew that if Odira was desperate enough to call for help, Crystal was sick.

"Hundred and two." Odira's voice sounded like a solid mass in the confined space. "Couldn't get her temp down, and the coughing just kept getting worse. Think she might have pneumonia again." She sniffed and wiped at her wet face with the back of her hand. "Sorry… just couldn't figure out nothing else to do but call you."

"You don't have to apologize, Odira." Mercy laid her heater-warmed hand on Crystal's face. Yes, it was hot. Crystal's underdeveloped body was always fighting some kind of an infection. She'd had bouts of both bronchitis and pneumonia since Odira took over her care last year. Who knew what nightmares the child had suffered before that? She talked more now than she had when she first came to Knolls after her mother disappeared. She was healthier, too. That didn't surprise Mercy. Love and kindness had great power over illness, and nobody could envelop a little girl in love the way big, awkward Odira Bagby could.

Mercy shared the hope with Odira that they would see Crystal live to adulthood, maybe even into her forties, with the new treatments and increased knowledge about this debilitating genetic disease. And by the time Crystal reached her forties, maybe they would have a cure.

As Crystal's coughing and wheezing increased, Mercy turned onto Maple, the street that fronted Knolls Community Hospital and her clinic. The hospital came into view, glowing a dark rose color in the security lights set strategically around the grounds. Mercy slowed to the required fifteen miles per hour as she passed the property, set in a scenic residential section of town, with plenty of open lawn and evergreens. Bare branches of oaks and maples jutted out from between humps of burlap-protected rose plants.

She looked up to see, without surprise, that the administrator's office was illuminated on the second floor. Mrs. Pinkley had opted to move her operations into an unused storage area rather than take the time to repair her own suite, which had been damaged in the explosions when the E.R. was destroyed. The E.R. was Estelle Pinkley's first priority. Knolls Community usually employed about two hundred fifty people, many of whom would be out of work until they had the west wing with an emergency department. Estelle's sense of civic responsibility had impacted her career as prosecuting attorney for a great deal of her life. Why stop just because she'd changed careers? At seventy, she was a more powerful force than a whole roomful of attorneys.

Odira sniffed and wiped her face again. "Sure do miss Dr. Bower." Her heavy voice had an unaccustomed catch of sadness. "Bet you do, too. Bet you get all kinds of calls like this since there ain't an E.R."

Mercy reached over and patted Odira's fleshy shoulder. "You know I wanted to come." But what the woman said was true. Mercy's practice had been overwhelmed the past three months. She missed Lukas a lot, and not just for his professional ability.

Lukas Bower, the acting E.R. director, was working temporarily at a hospital on the shore of the Lake of the Ozarks, a three-hour drive from Knolls. Patients and hospital staff members continually asked Mercy when he'd be back. She wondered, too. Nobody missed him more than she did.

"Don't seem right he should be out of work just because some monster wanted to set fire to the E.R." Odira pulled Crystal closer. "Don't seem right we should all be suffering like this."

"I feel the same way." Mercy looked down at Crystal. "How are you doing, sweetheart?"

"My chest hurts."

Mercy bit her lip and prayed silently, the way Lukas had taught her to do. God, please help me with this one. She's so young. Why is she suffering like this? The question came up often lately in Mercy's mind, and after all the talking she and Lukas had done about the subject, she still hadn't found a satisfactory answer. Every time she found herself questioning God about it, she felt afraid. Sometimes it seemed as if all those great, profound truths she and Lukas had discussed last summer and autumn had deserted her, and that her new belief in Christ was just a fairy tale.

She turned into the dark parking area of her clinic, less than a block from the hospital. "Let's get inside and get a breathing treatment started."

Clarence Knight just happened to be in Ivy Richmond's kitchen, raiding her refrigerator and practically swallowing three frozen chocolate chip cookies whole, when the phone rang for the second time Saturday night.

He jerked backward and knocked his head on the overhead compartment where Ivy had been hiding the treats from him. He thumped his elbow on the door and spilled crumbs down the front of his size 6XL T-shirt in his rush to get to the phone before the ringing could wake Ivy. If she came in and found him eating, she would roast him whole over an open fire, all four hundred twenty pounds of him.

He jerked up the receiver, then realized his mouth was still full. He chewed and swallowed. "Mmm-hmm?"

"Hello? Who is this?" It was a man's voice. Sounded familiar. Sounded upset. "Clarence?"

"Mmm-hmm."

"Is Dr. Mercy there?"

Clarence swallowed again. "Hmm-mmm."

"Do you know where she is? This is Buck. I just tried her at home, and I couldn't get her. I need her bad. Kendra tried to—" His voice broke. "She needs help. I've got to get her somewhere…got to get her on some oxygen." There was another crack in his voice. "Clarence? You there?"

Clarence swallowed again. "Hol' up, Buck. Ith's okay." One more swallow. There. "Mercy dropped Tedi off here a little bit ago, 'cause she was on her way to the clinic for some emergency. What's the matter with Kendra?"

Buck took a breath. "She tried to kill herself. Carbon monoxide poisoning. She was running her car motor out in the garage when I found her. The doors and windows were all shut."

Clarence grunted as if he'd been hit in the gut with a football. "Oh, man." Poor Kendra. And poor Buck. "She okay? Where are you?" He knew they were still having trouble in their marriage, but was her life bad enough for her to want to die?

"We're still at home. I've got to get her to Dr. Mercy's," Buck said. "There'll be oxygen there."

"Yeah, Dr. Mercy'll check her out. Want me to call the clinic and see if I can let her know you're coming?"

"Yeah. Thanks, Clarence."

There was so much relief in Buck's voice, Clarence went even further. "You'll be coming right by here on your way…." He hesitated. He'd just started getting back out into public after losing all that weight, and he still had a long way to go. Could he do this?

Yeah, he'd do anything for Buck. Buck had been there for him when he was in trouble. "I could meet you out at the street. All you'd have to do would be stop and let me get in and ride with you. Then you wouldn't have to do this all by yourself." And maybe he could talk to Kendra some. He knew firsthand what depression could do to a person.

There was a pause, and he braced himself for Buck to turn him down. He'd lost over a hundred pounds since last spring, but he'd still draw a big crowd at a circus sideshow. He was big and clumsy and took up two seats wherever he went, and strangers stared and laughed, and he knew the few friends he had were probably ashamed to be seen—

"You'd do that for me, Clarence?" came Buck's relieved voice. "It would help."

Clarence blew out a bunch of air he hadn't realized he was holding in his lungs. "Sure would, pal. Look at what you did for me last fall. I'll be waiting out front when you get here."

He hung up and glanced toward the hallway that led to Ivy's bedroom suite. Good. No lights, and he thought he could hear her snoring over the hum of the refrigerator. Mercy's daughter, Tedi, had gone straight to sleep in the spare bedroom without waking her grandma. He guessed neither of them had heard him on the phone.

Ivy had once compared his voice to a derailed locomotive running loose through the house, and she really griped when he woke her up in the middle of the night. Especially when she caught him eating.

Clarence and his sister, Darlene, had come to live with Ivy Richmond—Dr. Mercy's mom—three months ago when their health got too bad to live on their own. And Ivy had bullied him every day since then to eat right, exercise, take his vitamins, exercise, take his medicine, drink a bucket of water a day and exercise. She'd even tried to make him go to church with her. He'd done everything but that.

Since he couldn't bend over and pick up all the crumbs he'd scattered on his way to the phone, he shoved them aside with his foot. Though sloppy and crude, it might save his life. He had to hurry and brush his teeth and get out to the curb. He wanted to be there when that pickup truck came rolling by.

Shouldn't've taken that Lasix a couple of hours ago. He knew from Mercy that the medicine kept him from retaining fluid, but it also kept him running to the bathroom all night long.

Crystal Hollis lay on Mercy's softest, most comfortable exam bed in an overheated room, with a pink teddy-bear sheet draped over the lower half of her body. Some of the color had returned to her face, and the sound of her breathing was not as labored, nor her lips as blue, as a few moments before.

Mercy pressed the warmed bell of her stethoscope against the little girl's chest. "Take a breath for me, honey."

Seven-year-old Crystal had the body weight of a five-year-old, with stick-thin arms and legs and a slightly protruding abdomen—clearly the cystic fibrosis affected her pancreas as well as her pulmonary system. Which meant Crystal could eat as much as an adult and still not put on weight. It was a constant battle. She had an aura of maturity in her long-suffering expression and sad gray-blue eyes that befitted someone seventy years older.

Her chest sounded a little better, but not enough. She coughed and Mercy grimaced. The breathing treatments weren't going to cut it this time.

"How's she doin', Dr. Mercy?" Odira's deep voice rumbled from her chair four feet away. She leaned forward, her puffy face filled with tense worry.

Mercy sighed and placed the stethoscope back around her neck. She tucked the sheet back up over Crystal's bony shoulders and took the little girl's hand in her own. "I'd like to see her breathing better, Odira." She perched on the exam stool beside the bed and faced the child's great-grandmother. "The X-rays don't show what I suspected, but this could be early pneumonia. I'd like to have her checked out by a pulmonologist in Springfield. I could transfer her to St. John's and…" The expression of sudden fear in Odira's face halted her words.

"But you're her doctor," the older woman argued. "You're the one we trust. Couldn't you just do one of those consults they talk about on TV? That big place up in Springfield would be so scary for Crystal, and they might not even let me stay with her. You know how those big places are."

Mercy patted Crystal's hand and released it, then stood up and walked over to the chest X-rays placed in the lighted viewer box. The films most definitely indicated bronchitis. Time to blast those lungs with high-powered antibiotics. Odira always made sure Crystal received the nutritional support Mercy suggested, including the pancreatic enzyme supplements and vitamins, but Mercy would increase the caloric intake even more for a while. Crystal's fever had dropped a little, but Mercy didn't want to take any chances.