DORSET, 2010
ONE YEAR LATER
The faint morning bustle that washes up the lane from the village has faded. The morning sinks into a dull afternoon and, unannounced, grief settles closely around me. It will pass as long as I stand quite still. On home visits in the past, I could tell from the door if patients were sick by how still they lay. Appendicitis, a ruptured abdominal aorta, meningitis—the muscles become rigid to shield the disaster unfolding inside. In the summer I lay motionless as the hours dissolved, watching the dust dance in glittering columns as the sunlight slid through each window in turn. I wanted to die, but I knew then as I do now that one day I might look up and she could be there, framed in the doorway. And, of course, I would never abandon the boys; besides, her dog sleeps in my kitchen.
On cue Bertie yawns, climbs out of his basket, and wags his tail. His opaque eyes track me as I cross the kitchen. His neck is warm under my fingers when I clip on the lead; the deep fur has toughened with age. I shove the notebook and pencil into a pocket. The back door of the kitchen opens into the garden, which leads onto fields. Mother gave me the cottage before she died. It was lucky that she did; it gave me somewhere to hide.
Lucky. Good luck, this is my lucky day, wish me luck. A trivial word to describe the weight of those swings of fate that open or close against you, like great doors banging in the wind. Naomi never thought she would need luck. She thought she had been born lucky. I thought she had been too; I thought we all had been. Only a year ago, I thought we had everything.
It’s hard to see exactly where it began to change. I go back, over and over again, to different points in time, to work out where I could have altered fate. I could pick almost any moment in my life and twist it to a different shape. If I hadn’t decided to become a doctor, if Ted hadn’t taken the books out of my arms in the library years ago, if I hadn’t been rushing that afternoon in my office, if I’d had more time. Time was running out but I didn’t know it then.
I climb the cliff path, waiting as Bertie jumps stiffly up the ledges of gray rock. At the top the wind blows spray against my mouth like rain. It seeps between my lips, salty, more like tears than rain.
My mind goes to the afternoon in my doctor life, when the clock started ticking down the hours of Naomi’s last days with us. The afternoon I met Jade, the chili in my eye.
Sitting on a rock, the sea and sky stretching in front of me, I pull the sketchbook from my pocket and begin to draw a toy giraffe, smudging the coat and making the edge of one ear ragged. Bertie settles to wait, his head on my feet, whining softly from time to time.
On the second of November a year ago I had no way of knowing that we had only seventeen days left.
BRISTOL, 2009
SEVENTEEN DAYS BEFORE
It had been raining all day. Patients were coming in off the narrow street with dripping clothes and wet hair, letting in the swish and rumble of the main road at the end of our little cul-de-sac. Our practice was near the docks, set back a little between a pine furniture shop and a rubbish-strewn parking lot where the weeds grew high and thin through patches of broken tarmac. The streets nearby were dense with small Victorian terrace houses; when I drove to work, nudging the car through the narrowing streets, I would glimpse the dark water off the docks between old warehouses.
The practice was popular, or perhaps just convenient. The small waiting room was always crammed with patients, though the few minutes we had for each never seemed enough. In the allotted seven minutes it was almost impossible to give people what they wanted. All the same, I thought they knew we were on their side; at least I thought so until that afternoon. I remember quite a lot; in particular I remember the smell.
By late afternoon, my room smelled bad. Sweat, blood, and stale alcohol. Flesh took on a greenish color in the harsh overhead light. The blinds were drawn over the window to keep out the street, and in here it was as though that world didn’t exist. It was hot. Toys were scattered over the floor. The basin in the corner was full of bloody metal, covered over with blue paper towels.
I was tired. Mrs. Bartlett’s examination had been difficult—it had been hard to see the cervical polyp for the bleeding—and she would need referral to a clinic tomorrow. I glanced at the list on my screen, and as I cleared the basin, then washed my hands, I thought about the next patient. A temporary resident. Yoska Jones. Polish? I yawned into the little mirror above the sink; my hair had escaped the clasp and was wildly curling around my face. My mascara had smudged again. I narrowed my eyes at my reflection, hoping his problem would be straightforward so I could make up time. I called him in. Mid-twenties. High cheekbones, tanned skin. It took a second to see he wasn’t ill. I could sort this quickly.
“How can I help?”
“Back pain, runs in the family.” A Welsh accent. His hand, strong and weathered, lay close to mine on the table. I put my hands in my lap.
“What do you think brought this on?”
“Carrying my kid sister around.” A defensive note crept into his voice. “She likes to sit on my shoulders, but she’s getting heavy.”
“Carrying children doesn’t help.” It’s tempting, though. I used to carry Naomi everywhere, long after she could walk on her own. I liked the weight of her, her face against mine. “Best to let her walk on her own.”
I caught a flicker of anger in his eyes, but in seven minutes advice was more important than sympathy and I had to look at his back. The long erector spinae muscles on either side of his spine were as smooth and thick as a pair of snakes, but when he lay on his back he winced as I raised his legs. Sciatica. His reflexes and sensation were normal. When I told him what exercises he needed to do and prescribed some analgesia, he smiled and shook my hand. The laying on of hands had worked its magic: his hostility evaporated completely. He left with a leaflet of advice and his script, his foot accidentally tipping a toy as he went. It spun across the room and crashed into the wall. I picked it up as the door closed. It was the little plastic duck with the faded orange beak that had been chewed so often it was frayed into soft spikes, and the wing had come cleanly off, leaving a sharp edge. There was a muffled clang as it hit the bottom of the metal garbage can. I called the next patient in.
I knew Jade was ten, though she looked much younger. She stood motionless as her mother took off her parka, her school sweater, her skirt. There were bruises on her face, her arms, and her legs. She seemed perfect apart from the bruises, but her pretty face was blank. She watched me closely as she clutched a tattered velvet giraffe. I had seen her at least four times this year; there had been tiredness, ill-defined abdominal pain, poor appetite, and now coughing. Nothing had jumped out at me before, though I had noticed her dirty clothes and the matted hair that hung in silvery ropes. I had simply given advice, and tried to reassure her anxious mother. This time it was different. The bruises were new. I smiled at Jade, but the room seemed to turn darker around her.
Her mother, in bulging fake fur, talked quickly and loudly, leaving no gaps between her words. Gaps held clues, but her words fell out in a tight line.
“Still keeping us awake with the bloody coughing.”
The woman’s hard green eyes tracked mine.
“Something else as well.”
The caked face pushed in close and little blobs of hardened mascara trembled when she blinked. Her fingers with long pointed nails gripped her daughter’s shoulders tightly.
“She comes home covered in bruises. She says she trips over a lot. We think it’s the other kids. Picking on her.”
“Why are they doing that?”
“I don’t know, do I?”
I uncurled Jade’s fingers and put the steel disk of my stethoscope into the small palm so its coldness on her chest wouldn’t shock her.
“Can I listen to your tummy?”
The bright head made a small movement up and down.
I put my stethoscope on top of her undershirt first to gain her confidence; her hair fell over my hand and I saw something black scuttle up a strand toward her scalp. When she stopped holding her breath, I lifted the undershirt to listen and saw that the bumpy little rib cage was bruised; there were more bruises on her backbone. I could hear the mother’s voice become louder and faster as she watched me, but I stopped listening to the words. I kept my face under control as I felt the tender lumps on a rib. There were small crackling noises in her chest. I examined her everywhere. By the time I saw bruises high on her inner thighs, wings of worry were beating in my head.
I typed a script for antibiotics as her mother pulled her clothes back on over her head. If I mentioned the lice as well, she might never come back.
“This should help her chest; she needs a spoonful three times a day. I’ll need to check her again, so could you bring her back in two days?”
She nodded, staring at the script in her hand, and turned to go, pulling Jade after her quickly.
I went to see Lynn, our practice nurse. She was in her room, humming quietly as she refilled her tray with bottles and syringes. When I told her about Jade, her brown eyes narrowed in concern.
“Jade’s never been brought in for immunizations. She saw the substitute nurse last summer, bad fall, grazes to her arms.” Her neat hands flew over the keyboard. “The father was here a few weeks ago as well, stitches in his hand. Off his head with alcohol that afternoon.” She glanced at me with a worried frown. “I had the feeling he would lash out at any moment.”
I had encountered drunken men with open head wounds on Saturday nights in the emergency room while training. I remembered the obscene threats, the wildly aimed punches while I sewed skin edges together with trembling fingers.
So Jade’s father was that kind of man.
“What do you make of the mother, then, Lynn?”
“Don’t really know.” Lynn leaned toward the screen. “Doesn’t come in for her smears. It’s on here that she saw Frank for depression last year and was prescribed citalopram, but she didn’t come back for follow-up.”
As she spoke, the pieces of the jigsaw began to slot together neatly.
“Thanks, Lynn. Any chance that you could, say, contact the mother about the immunizations . . . ?”
“And use it as a chance to go visit? ’Course I will.”
I phoned the social worker, left a message. Tracking down the school nurse took longer. It wasn’t the day for her drop-in clinic, but the school gave me her work cell number. She picked up on the second try.
“Jade Price? Yeah, I know Jade. Quiet little thing. Not a happy child.”
“Why’s that?”
“She gets left out. The other kids treat her like a leper.”
The raspy voice wanted to gossip. I kept it brief.
“Does she get into fights? Her mother said—”
“Like I said, the kids don’t go near her, too quiet. The nits don’t help. Her dad fetches her from school sometimes, drunk as a lord, full of temper.”
Another piece of the jigsaw clicked into place. The community pediatrician was out; I’d try later. As the senior partner, Frank would need to be told, but it would have to wait until tomorrow now, as I was running late. The patients would be waiting with pursed lips, checking their watches. The beating wings of worry had gone, leaving a feather edge of panic. When my cell phone vibrated in my pocket, I picked it out and gave it a fleeting glance. Ed. I’d have to remind the children not to phone me here; there was never time to talk to them. I called the next patient in.
Nigel Mancey pushed his insurer’s medical report across the desk at me. “They’re on about how I’ve got blood pressure.” He grinned.
As I wrapped the cuff around his curdy white upper arm, his thick fingers tapped the table; they looked like shiny pink sausages, the cheap kind with thin skins that split open with one touch of the knife. His blood pressure was high but not dangerously so. He took the lifestyle booklet and blood test forms, then left to make a follow-up appointment, muttering to himself.
The air in my little room seemed used up. I was grateful when Jo, our receptionist, brought me a cup of tea between patients. She wore her fair hair piled high on her head, but by this time of day little strands were straggling loose. She set the white china cup gently down in a space on the desk between notes. As I took the first sips, I looked at the framed photographs on the wall. They were out of date now. There was one of Naomi at five, smiling so broadly her eyes had disappeared, tightly holding Bertie, then a new puppy. The boys were leaning in, half hidden, grinning down at her. There was another from a party the previous New Year’s Eve. Ted’s arms were around us all; he must have said something funny because we were all laughing except Naomi; she was staring at the camera so intently she seemed to scowl. I pulled my attention back and called the next patient in.
The dark afternoon eased into evening. Patient followed patient in a steady rhythm and for a while I felt I was winning. Then Jo put her head around the door, her eyes wide with worry: little Tom had just been brought in with an asthma attack. His mother, a pretty teenager with dreadlocks, was silent with fear. Tom was sweating, his skin tugged in between his ribs, the wheeze was ominously quiet. I switched into automatic mode: soon he was breathing in Ventolin bubbled with oxygen through a pediatric mask, too tired to resist. His head began to loll, and he slept deeply. The ambulance arrived soon afterward to take them both to the hospital so he could be stabilized overnight.
The room was quiet after they had left. My stethoscope lay on top of tattered envelopes with notes spilling out. Blood forms were jumbled together and a wooden tongue depressor was on the floor. The beige surface of the tea was ringed with a milky white circle. I did all the end-of-office things, tidied notes, and recorded letters on the dictaphone to the pediatrician and social workers. No visits. Jo left for home, her good-byes echoing in the empty waiting room. I made a list of things to do in the morning and stuck it on the black face of the computer.
The street was empty. Orange lights shimmered in the oily puddles. The pine furniture shop was shuttered, and faint noises and shouting laughter came from the pub. My old Peugeot was alone in the parking lot; with my back to the dark space behind me, I fumbled for the keys, fear briefly prickling in my mouth. Once inside, my other life was instantly present in the smell of dog, mud, and wet suits; it reminded me of the fullness of our lives. What we had was hard won, but most of the time I knew we were lucky. There was a tattered sheet of math homework on the floor and a pair of sneakers stuffed under the front seat. I found a jelly candy in a crumpled cellophane bag jammed into the side pocket. It tasted sugary and sharp. I turned on the ignition and eased the car forward.