“Jimmy has some enlargement of his spleen,” Harper said immediately, her tone calm and matter-of-fact. “That’s an organ in his belly like the glands we have in our neck that get swollen when we have a cold. I’m not finding anything else that might be causing his problems. There are a lot of things that could cause his symptoms, and I think we need to put him in the hospital to do some tests.”

“Hospital?” Emmy grabbed her husband’s arm with one hand and reached for Harper with the other. “God, Harper. Is it bad?”

Harper took her hand. Don Reynolds slid his arm around his wife’s shoulders almost as if he needed to lean on her to keep standing as much as to comfort her.

“I can’t tell, Emmy,” Harper said. “It might be something as simple as a virus or it could be something else. Whatever it is, I want to find out quickly so we can start to take care of things. Can you get someone to come stay with Darla so you can take him over to the hospital?”

“Tonight?” Don Reynolds’s voice cracked. “You want to take him to the hospital tonight?”

“I think that would be best. He hasn’t been eating, and he’s probably dehydrated. He’ll feel better when we give him some intravenous fluid, and I can get the tests I want started right away.”

Don looked at Emmy, his expression stunned. “I…I can call my mother. She’ll come over.”

“Good,” Harper said.

“Don, honey,” Emmy said soothingly, “why don’t you go call your mom. I’ll talk to Jimmy.”

“Okay, sure. I can do that. Sure.”

Emmy watched her husband trudge away before asking Harper, “Can I stay with him in the hospital?”

“Absolutely. Once we get him settled, we’ll have the nurses bring a cot into his room for you.”

Tears glistened on Emmy’s lashes, and she brushed at them impatiently. She stared down the hall as if checking to see they were still alone. “Harper, I want the truth.”

Harper brushed Emmy’s shoulder. “I’m telling you the truth, Emmy. I don’t know what’s wrong.”

“But you suspect something, don’t you.”

Harper smiled, still calm and unruffled. “It’s my job to be suspicious. That’s why I want him in the hospital. My guessing right now is not going to help him or you.”

“We don’t have insurance. Last year’s crops were so bad, we had to let it go.”

“There are ways to handle that. And now is not the time to worry about it. What matters is Jimmy.”

“I want you to tell me first, soon as you know. Don…” Her voice shook. “Don is the best husband I could ever want, but he’s not strong about some things. He won’t…if it’s bad, he won’t do good.”

“You first, I promise.”

“All right, I’ll go talk to Jimmy alone if you don’t mind. If I need you, I’ll call.”

“Sure. You go ahead. Pack enough clothes for a few days.”

Emmy stopped and gave Harper a hard look, but finally disappeared.

When the door closed, Harper sighed tiredly and rubbed her face. Presley wished she could help her—help all of them somehow—and had never felt quite so useless in her life.

“We’ll be ready to go in just a few minutes,” Emmy said when she came out. “As soon as Don’s mother gets here.”

“All right, I’ll meet you at the hospital,” Harper said.

Emmy Reynolds nodded distractedly. “I’m going to get Darla ready to go to Sally’s.”

Harper and Presley let themselves out. When they reached the truck, Harper said, “I’ll take you home.”

“No,” Presley said. “I’m in the opposite direction from the hospital. The family will need you to be there when they get there, and I’m sure you have things that you need to do before they arrive.”

“I could be there a while.”

Presley opened her door and climbed into the truck. “Then we should get going.”

Harper got behind the wheel, grateful that Presley understood without her needing to tell her what was happening. Cases like this were some of the hardest she ever had to deal with. Emmy was scared, Don was terrified, and she feared she wouldn’t have good news for them. She started the truck and headed for the Rivers.

“Can you tell me what you suspect?” Presley asked.

Harper sighed. “Both his spleen and liver are enlarged. A boy his age, with his symptoms, we have to worry that he’s got leukemia or lymphoma. Either one is dangerous. It might be something simpler, but…”

“But you don’t think so.”

“No,” Harper said, “I don’t think so.”

“Are these things treatable?”

“Yes, and a lot more successfully than ten or twenty years ago, depending on exactly what he has. No matter what the type, though, if he has leukemia, he’s in for a rough ride. So are his parents.”

“God, that’s horrible.”

“Yes, it is.” Harper glanced over at Presley. “I’m sorry, this is going to take a few hours. Your night will be shot.”

“Don’t be silly. Just do what you have to do. I’ll be fine.” Presley clasped Harper’s wrist. “If I were home, I’d probably be working. I can do that while I wait just as well at the hospital.”

“You work too much.”

“Says the doctor who makes house calls on Saturday night.”

“I can see why my father liked company. It helps.” Harper turned her hand over to grasp Presley’s. Presley’s fingers on her forearm were comforting, a connection she welcomed as she thought about the night ahead and the pain she was likely to bring to Don and Emmy. Pain not of her doing, but pain she would have to deliver all the same. And she worried about Jimmy, a boy who shouldn’t have to deal with anything more serious than improving his baseball swing and what he would do on summer vacation. She held Presley’s hand a moment longer and let go.

“I’m glad it helps,” Presley said softly. “And I’m glad I’m here.”

Chapter Nineteen

“I’ll be in my office,” Presley told Harper as they stopped in front of the ER entrance. “I’m sure you’ll be tied up awhile, so don’t worry about calling.”

“I will when I’ve finished,” Harper said. “But if you want to leave—”

“I won’t, but if I do, my car is here. So don’t worry about me. I’ll be fine.”

The big red-and-white sign overhead painted Harper’s face in stark relief. Gone was the quiet, careful woman who favored a secluded hideaway up among the branches of a great oak. Her jaw was set in granite and a hard light burned in her eyes. The warrior had emerged, and seeing her this way was enough to make Presley believe she was undefeatable. The family would believe that too, she had no doubt. “If I can do anything—”

“You have.” Harper stared up at the blazing sign and the building looming beyond. “I love this place, but there’s a lot of pain inside these walls.” She glanced at Presley. “Sometimes it’s lonely.”

Presley’s throat tightened. Had she ever been this brave? Had she ever admitted, even to herself, all the things she longed for? “Not tonight.”

Harper touched her hand. “No. Not tonight.”

“Go, do what you need to do. I’ll be here.”

“Thanks,” Harper said.

They parted company just inside. In her office, Presley settled behind her desk and pulled up the projections Preston’s team had provided along with the hospital financials she’d collected earlier. She keyed in data and ran various scenarios, looking for loss points and duplications, wide margins between billables and receivables, searching for the places where the cash flow might be converted from negative to positive. Unfortunately, one of those areas was the number of staff—an overabundance or poor allocation of staff was a drain on resources.

She appreciated the importance of a low staff-to-patient ratio, but in some areas where patient outcome was not as critically impacted by a higher ratio, some of the nursing and technical staff could be reassigned or even eliminated. The same, she was certain, was going to show up in many areas of direct services. The physicians themselves were not salaried, being private practitioners with admitting privileges who consulted at the hospital and admitted patients when necessary. Those patients then funneled revenue into the system via their insurance or, in rare instances, direct pay. Unfortunately, as she scanned the accounts for the last five years, it was obvious the percentage of insured and/or direct pays was declining and the percentage with some kind of state or federal assistance rising. Patients on government subsidy had a very poor ratio of billables to receivables. And worst of all were the self-pays, which almost always meant no pay.

She leaned back, thinking about Jimmy Reynolds. His mother had said they had no insurance. They were a prime example of the working poor who couldn’t afford insurance, despite being above the poverty line. Who would pay for his care? Should it be the hospital’s burden, when it meant that too many Jimmy Reynoldses would result in no hospital at all? Should the community shoulder the burden, through taxes paid to the state that were used to provide medical assistance for families like Jimmy’s? Or, as the current administration proposed, was the answer in federally guaranteed health care? Would health care for all result, as it had in so many other countries, in a two-tier system where those who could afford private insurance would always have it, and with it, greater access to the system—the best doctors, the hospitals of their choice, and the most expedient care? Presley couldn’t change the system, she could only figure out ways to work within—or more often around—it. And no matter how she aligned and realigned the numbers, the Rivers needed a new source of revenue and a way to stop the current losses, or as Preston had rightly predicted, it would die.

A few days ago, that conclusion would have been not only inevitable, but totally acceptable. Now part of her wondered if there might be a different solution somewhere. At the very least, they could look at the reimbursement structure and perhaps find a way to cut the losses in that area during the transition. Carrie had already begun working on that. In the meantime, she would proceed with the current plan to convert ACH to a more lucrative institution. Ideally, SunView’s goal was to repurpose the physical plant with the least amount of construction. Usually, with staff already in place as it was here, that meant either a rehab center with long-term care potential or a retirement community with nursing care facilities.