• 10 •

In the second year of residency every doctor-in-training was set up with a fledgling clinic practice one afternoon each week. In many ways these four or five hours out of the eighty- or ninety-hour work week were the only ones that resembled the life they would lead after they graduated, caring for average ambulatory patients with average ambulatory problems. Their hospital work was more exciting. Almost always. To be admitted to a hospital, patients had to be so thoroughly diseased or traumatized there was no option to send them ambulating right back to their homes. The only real difference between their resident’s clinic and the private practice most of them were headed for was that all the patients were poor, uninsured, and had no other doctor to call. When their pain or breathlessness or swollen joints became unbearable they would start in the emergency room, waiting hours to be questioned and examined by student doctors who sporadically excused themselves to consult a small library of textbooks in the cramped office behind the triage desk. After enough inspection of cavities and orifices and blood and X-rays for the residents to reach a plausible diagnosis, the patients were discharged with instructions printed out on a half sheet and stapled to the bill they couldn’t pay: “Take all your pills, watch for swelling and redness, change your dressing twice a day, follow up with your physician.” Thus, in rotating order, the doctorless were matched up with the doctor trainees who needed living and breathing specimens to learn their trade. It was a nicely symbiotic arrangement, on paper. But it will be different here in Hallum, at Dan’s clinic, Claire thinks. Her patients will have a choice. They will choose her. They will want her. She will have time for them.

She parks the Audi near the clinic steps and opens the door, then shuts it again and scrounges through her purse for a brush and her lipstick. When she angles the rearview mirror toward her face she is almost startled by the nervous look in her eyes. Who wanted to be treated by a nervous doctor? A dark shape cuts across the window and she nearly jumps to the other side of the front seat. Then Anita bends low enough to look inside the car. She smiles and jangles her key ring, apparently assuming Claire has already discovered the front door is still locked.

As soon as Claire is out of the car Anita starts telling her how many patients they have scheduled for the day, which ones will be no-shows (because yesterday was payday), and which ones will bring their whole family in without an appointment (because whenever they can get a ride to the clinic they pile grandma and all the babies into the truck to see Dr. Zelaya without even considering how tired he gets at this age), and which ones will show up just as she’s trying to lock the doors tonight, but this time she is not going to be softhearted about it. Her feet get too swollen by the end of the day to put up with these delinquents.

“When is your baby due?” Claire asks her.

“Not soon enough! I’m only four months. But it’s number three. No more belly muscles, I guess. I pooched out really quick this time. I washed your coat for you.”

She points to Evelyn Zelaya’s newly ironed white coat on a hanger just beyond the waiting room, drops her bag onto the floor behind the desk and begins turning on lights and the computer. “You know how to make coffee, right? I hope better than Dr. Z.”

Dan comes in the back door ten minutes later. He asks her just to shadow him for the first few days. A weight lifts when she realizes she won’t have to tell anyone she is their new doctor. Not yet, anyway. He introduces her to the patients as his “colleague.” They look at her, then shift their eyes back to Dan for some confirmation of trust before they smile or nod and allow her to melt into the background. She stands tucked into the corner behind the exam room door—her starched coat with the false name embroidered on it, her hands rigid in the empty pockets—and tries to pick out words she understands. Dolor, sangre, sarpullido, pastillas, pinchazo… She tries to piece caught words and phrases into symptoms or cures, tries to work them into questions she will need to ask some patient within a few days, if Dan doesn’t change his mind about her. In medical school she had learned a fair bit of Spanish at the public hospital. Even Seattle, as far as you could get from Mexico, had a densely woven Hispanic world populating the apartments and row houses of Beacon Hill and the Central District.

A little after nine the back door slams open, sending a shiver along the wall and a gust of snow across the mat. “You’re late,” Dan calls out without looking up from the medical chart he’s making notes in.

“I’m early. This the new doctor?” Frida, the clinic’s nurse, is a compact woman with skin the color of brown eggshells, who wears her black hair twisted up in a hot-pink bandana, socks and sandals on her feet despite eighteen inches of snow. She flashes a stunningly toothy smile at Claire and from then on acts as if they’ve worked together for years. Claire finds the sense of being taken for granted enormously reassuring. “How’d he get you suckered into this job?” Frida asks, shaking more snow off her coat onto the floor and pouring herself a cup of coffee. “He must not have told you what it pays, that’s for sure.”

Claire glances at Dan, who has not lifted his eyes from the chart. She sees the corner of his mouth twitch, and when she looks back at Frida she’s laughing. “You should give her a raise just for making a decent pot of coffee.”

Claire still hasn’t asked about the salary; she is forty-three years old, and this is the first time she has worked for a paycheck other than the assigned and nonnegotiable stipend of a resident. She hardly knows what to ask, as if she has any option. Her main financial goal is to make sure Dan doesn’t regret his offer.

By the time he pauses for their lunch—peanut butter and jelly sandwiches and peeled grapefruit—Claire is too numbed by her own ignorance to be hungry. She had scribbled a few notes on the sly in the first few patients’ rooms, worried that if Dan caught her he would slap up against how embarrassingly inexperienced she is. It feels like the medical journals she’s been reading for the last decade are little more than movies trying to imitate real life.

At the end of this first day she gives herself a competency test. She stands against the closed exam room door of the only patient still left in the clinic and imagines herself one step ahead of everything she sees and hears, translating the words she understands and anticipating Dan’s next move, which question he will ask, what physical exam he’ll do, what blood test he’ll order. She gives herself a score of 55 on a sliding scale weighted by the language barrier. Clearly failing.

Dan looks exhausted, a sallow shadow darkening the pockets under his eyes. Claire tries to apologize for all her questions, her fumbling, her inadequate Spanish, how she has slowed his pace and kept them all here past six. He stares fixedly at her while she talks until she runs out of words, at which point he squints his eyes, deepening the sharp groove that runs in the narrow space between his brows, and leans a notch closer, almost broodingly serious. “You’re not planning to quit on me, are you?” She shakes her head. And then he laughs, all the lines in his face breaking a new way. “Well, then. I’ll head home. Frida’s in the back—she can lock up.”

After she says good night Claire walks toward the front entrance, where she’d parked eleven long hours ago, the waiting room now lit only by the single streetlamp at the edge of the parking lot, a diffuse fluorescent gloom. She thinks, for a moment, that Anita must have left a radio on, but as soon as she nears the swinging gate at the end of the hall she recognizes the voice of a patient seen two hours earlier, a young woman from Guatemala who’s just started at Walker’s Orchards, come in with a complaint of headaches. Her back is turned when Claire enters the waiting room. She’s reading the symptoms of diabetes out loud from a poster on the wall. At Claire’s approach, she says, “Ah, Miguela. Mira. Es la mujer.” Then, holding open her small bag of drug samples: “¿Cuántas puedo tomar cada día?”

Claire is more startled when another woman’s voice comes from near the desk, behind her. “Oh, bien. Doctora, you have in Spanish?” Claire looks inside the bag and takes out one of the boxes—the directions are only in English. Dan must have been tired, to have forgotten the translation. She writes them on a blank sheet of printer paper and says the words out loud, hoping she’ll be able to tell from the woman’s reaction that her simple Spanish is clear: “Una pastill cada mañana, y una pastill de la noche. Claro? Dos cada día.”

“En la noche,” the woman standing behind her says, and Claire looks at her closely for the first time; a small woman, maybe thirty-five or so, a little young to be the patient’s mother. Suddenly Claire recognizes her. It’s the woman from the grocery store; the one she had glimpsed here at the clinic the first day she visited. She feels a rush of relief to see that the woman appears well. Claire hadn’t noticed her eyes before, underneath the knit cap she’d worn. They are almost too large for her petite face, accented by stark brows that arch toward her temples like wings, Claire thinks; the silhouette of a soaring bird.

Claire holds out her hand, feeling almost like she’s run into some old school friend, surprisingly happy to stumble on some link in Hallum that doesn’t ache of her former life clashing with this new one. “¡Señora! Cómo está?” The woman glances at her friend and back to Claire, in a puzzle. “The jacket,” Claire exclaims, trying to come up with the Spanish words. “At the grocery store. Chaqueta.” At last her face breaks open into recognition and she smiles, darts over to the coat rack and pulls off Addison’s red and cream plaid wool lumberman’s jacket.

Sí, sí. Muchas gracias, señora. So warm.” Claire remembers her voice now, too, the English words heavily accented, as if she has learned them from a book with almost no verbal practice.

“So you have a friend here?” Claire makes the circling dance with her finger again, this time indicating the two women. “¿Amigos?”

Amig as,” she corrects, but shakes her head. “Sólo estoy ayudando a ella esta noche. Only helping.” With that she turns to the younger woman and asks her something before they both put on their coats. “Thank you, doctora.

De nada,” Claire answers. Just before she locks the door after them she asks, “¿Cómo se llama? Your name? What is your name?”

The woman is all but hidden inside Addison’s jacket; its masculine bulk makes her look unusually vulnerable, but she reaches out her hand and takes Claire’s with an assuredness uncommon among the patients she’s met today. It is as small as Jory’s. “Miguela. Miguela Ruiz.”

Claire raps on the bathroom door but Addison doesn’t hear her over the running water, and his voice—“Stairway to Heaven” in falsetto. She goes inside and closes the door, sits on the toilet seat. It’s comforting in the small steamy room, tinted with the scent of pine soap and the creamy smell of his shaving cream. Addison pulls the shower curtain back. “Hey! How was it?”

“Exhausting. Humiliating.” She unbuttons her sweater and twists her hair up off her neck. “Between you and me? I feel lost.”

He shuts off the water and pulls a towel from the shower curtain rod. “Well, it’s a totally new experience for you, Claire. You haven’t practiced medicine in fourteen years. How could you not feel lost?” He steps over the side of the tub with the towel wrapped around the soft bulge at his waist. He is heavier since he’s been on the road, eating fast food and convention dinners. Ordering the extra martinis that might close the deal.

“I thought I’d kept up better than this. I don’t know, I guess I was reading too many articles about the latest angiotensin receptor blockers and not enough about parasites and vitamin deficiencies.”

“Buy some new books—primary care stuff. You’ll catch up.”

She thinks about it for a minute. What possible image could she give him to bridge the gap between his concept of what a doctor is and this job. “I don’t know where to read about how I’m supposed to treat diabetes when the patient lives in a trailer with twelve other men. How do you keep a supply of clean syringes and refrigerated insulin?” She raises her hands to make a point and then lets them drop back into her lap. “I don’t even understand their language. I’m not sure I won’t end up doing more harm than good.”

Addison sits on the side of the tub and picks her hand up in his. His face is flushed and damp, erasing all the tiny lines that might show his age. Where does he hide his stress? “Do you want to go back to Seattle?” he asks. “You didn’t even try to find a job there.”

She plummets into the memory of her last lunch date with Anna at Chez Shea in Pike Place Market, the big arched window haloed with a wreath of Christmas lights. Anna. Married to Nash. She remembers joking with Anna about playing Ma on Little House on the Prairie in Hallum for a few months until Addison had time to repeat the animal trials and start another application for the human phase tests. Wishing she were allowed to say more, to tell Anna about Rick Alperts’s role in the fiasco, so she could stomp out the look of pity and doubt in Anna’s eyes. “Well,” Anna had said as she hugged Claire good-bye at her car door, “it’s all good.” Claire had wanted to lash out at her when she said it, and at the same time couldn’t blame her at all. Because it always had been good. For all of them. In one generation they had forgotten how heartless the universe could be.

A short, sarcastic laugh escapes her and she asks Addison, “If none of the clinics here would hire me without my boards, who would hire me in Seattle? Besides, we can live on half as much in Hallum. At least we own this dump.” She sees him take a breath and then quickly shut his mouth. “Sorry. This ‘graceful vintage home.’” His head falls forward at this. She takes the sharp edge off her voice and leans closer to him. “I am sorry. I’m just tired.” Drops of water have collected on his earlobes, suspended like jewels. Claire reaches up and touches one, breaks the surface tension so it runs down her finger. “You’re wearing diamond earrings.”

He looks at her, gripping the hand he still holds. “Speaking of, where is your ring?”

“Locked in the filing cabinet. Filed under ‘D’—either for ‘diamond’ or ‘debt,’ I haven’t decided. Felt funny wearing that ring to the clinic. It could buy a whole house in Mexico.” Addison nods. He looks so sad to her. So forlorn. She wants to forget every heated accusation and every splintered trust—hear them once, discuss them once, and forget them. But how do you do that? Why is it so hard to give Addison the same unconditional love she gives Jory? Is the heart for such absolute forgiveness granted only through childbirth? Instead, as always, any rub between the place they had been and the place they have arrived brings a curtain down between them. Claire is unwilling to turn from it this time. “I should sell the ring, Addison. It’s not like it was my real engagement ring. Buy me another one when you find an investor.”

He looks straight at her again, grips her hands so tight it hurts. “Please. Hang in there with me—a few more months.”

“I will. I am.” She says softly, feeling the sting of tears. “I’m trying.”

He scans her face, and she sees him looking for something there that she wants him to find. “Yeah.” He says after a minute. “Yeah. I know you’re trying.”

And she is trying, although the enemy dismantling their union is not always clear to her, leaves her wondering, sometimes, exactly what she is fighting. It is not about the loss of money, surely. She had fallen in love with Addison long before he was rich.

They’d met during her first clinical month in medical school, in the Harborview emergency room. “Initiation by fire,” the dean had editorialized with a wry smile when he read out her assignment. Addison had materialized out of the generally invisible cleanup crew in the aftermath of a multifatality car accident—materialized like a ghost in his orderly’s floppy white pants and tunic.

She was trying to write out admission orders for a patient with a hip fracture who’d been shunted to the back hall while the living were sorted from the dead. Her resident, Andy Keets, had whipped a blank order form out of a drawer behind the nursing desk and paused for a full two and a half minutes in his own scut work to bark out the orders she should use for a routine admission. Keets was a sharp, burly, aspiring surgeon who could be a comic guardian or a pitiless drill sergeant to his novitiate medical students, depending on whether he’d been allowed to wield a scalpel in the operating room or demoted to holding retractors. He terrified her. She’d scribbled the orders down in the little notebook she kept in a pocket of her short white coat, but she’d misplaced the book in the scuffle of the trauma room. Now she was lost in the middle of the sequence, somewhere between “Diagnosis” and “Vital Signs.”

Her pen hovered above the paper. She picked up the phone to page Keets, then hung up; it was safer to scrounge around among the blood-soaked drapes looking for her notes than to catch him in a foul mood. It was three AM. Her eyes were so tired her contact lenses felt like they were glued to her corneas, and the missing orders drifted from her memory like weeds on a tide.

She heard someone talking and jumped, realized she’d nodded off at the desk. God, she’d drooled onto the page and “Diagnosis” now bled into a faint blue pool.

“IV.” It was Addison, sitting on a parked gurney next to her sleeping patient, watching her write—and sleep. Claire wiped the corner of her mouth and stared at him.

“You have to say what kind of IV fluid to run. What do you want? Normal saline, D-five-W, lactated Ringer’s?”

She felt oddly insulted that an orderly would try to tell her how to admit a hospital patient. She knew she ranked low as a third-year medical student, but she’d rather have Keets chew her out than let a janitor see how lost she was in this foreign world that was supposedly her career. But the very next thought that skittered across her fatigued brain was He won’t age very well, but he looks so young now that won’t matter for decades.

He jutted his chin toward the paperwork. “Keets tell you the mnemonic?”

Now she was flustered, as if some mortal flaw in her intelligence were being exposed to someone that mattered. She started to stand up, ready to transport her patient up to the orthopedic floor by herself and figure out the orders there. She’d copy them from some other chart if she had to.

Addison hopped off the gurney and grabbed a pen and a clean order sheet from the desk drawer, and started writing capital letters down the left margin. “ADCVANDISSLD. A: Admit to floor. What floor’s she going to? Ortho, right?” Claire nodded. “D: Diet. Is she going for a hip pinning in the morning? So she’s NPO. C: Condition.” He glanced over at the rickety woman snoring lightly into her oxygen mask after a dose of morphine, her pulse oximeter flashing 97 percent. “Stable.” He moved closer, stood just behind Claire so that she felt the warmth from his body, saw the way his forearm flexed as he scribbled down the page. He reached the final D and wrote “Date?”

Claire looked up at him. “What do you mean? Date of discharge? I don’t know yet.”

“No. I mean you and me. A date?”

He couldn’t have timed it more perfectly, which proved to be an inherent, uncanny sense he had about the world, or at least the world of biochemistry. A second sight that made him millions until he focused too far. At that instant the elevator doors opened and Keets strode over to the desk. “Why is the hip still down here? I need you in trauma two.”

Claire snatched the pen away from Addison. “I wasn’t sure I got the orders right. You want to look at them?”

“Boehning, help her out, man.” Keets jerked a thumb at Addison, “Not even a doc and he’s smarter than any of you pitiful grunts.”

Hospital orderly work was only one of the menial jobs that had interrupted Addison’s education. He had a tuition scholarship to Harvard, but after his father lost his last bet Addison didn’t get any help from home. He’d gone door to door through Newton and Beacon Hill and Back Bay with a bucket and mop, washing windows all summer to pay for books and food. One year he’d cleaned cadaver tanks in the medical school anatomy lab. Claire didn’t know about it until Addison’s mother told her. She figured he’d kept it a secret because he was embarrassed, but when she discreetly asked him how he could stand it, Addison was nonplussed. “I had to get through school. I needed work I could do around my class schedule.”

He spent three years at Harvard working every weekend and holiday on a farm in the Berkshires, bunking in a half-restored schoolhouse out in the middle of a rotting apple orchard with trees gone as spiny as crabs. It was the one job he’d really enjoyed. He’d made a nightly ritual of lying in a fallow field until he counted three falling stars. In wintertime he would haul out an aluminum recliner, the nylon webbing busted through at the seat, and wedge it into the snow. Focused. Waiting. Uncompromising.

He told Claire about the farm on their first date, the very last D in ADCVANDISSLD. So she had taken him home with her after dinner, shoved all the blankets from her bed through a small window onto the roof of her apartment and lain for the first time in the hollow of his shoulder, arrested, astounded by the perfect fit of herself against him. He had teased her through the lyrics of Chapin and Dylan and Waites, counted out Bill Withers’s twenty-seven “I Knows” for the first time, like a premonition. They had watched the sky for hours, Claire undeterred by the obscuring lights of Capitol Hill and downtown Seattle, until three perfect stars fell. Three perfect stars that eventually led to a perfect family of three. Jory, Claire and Addison. Falling.