Chapter 9

Sarah’s last month as a first-year medical resident was grueling. She was on the medicine wards, with a wide variety of patients and diseases. Ninety-year-olds with pneumonia, sixty-year-olds with liver failure, fifty-year-olds with bleeding ulcers. The wards were busy, the patients were sick, and Sarah thought she herself might get an ulcer from all the stress. Even though she knew stress didn’t cause ulcers, just aspirin, NSAIDs, and a bacterium, Helicobacter pylori. Her stomach felt tied in knots all the time, like when she finally convinced a woman that her pancreatitis stemmed from too much alcohol, only to have her ask Sarah to keep this information from her concerned husband. Like when she had to tell a mother her twenty-one-year-old son, a delightful young man in his last year of college, would need dialysis for the foreseeable future, and maybe a kidney transplant.

She chided herself over this last patient. When she explained about dialysis, his mother cried. Then Sarah’s throat tightened and she was grateful she had finished talking. All she could do was put her hand on his mother’s. She couldn’t speak. She felt uncomfortable remembering this, and she hoped they hadn’t known she was on the verge of crying too.

If her patients saw tears, how would they take her seriously and have confidence in her recommendations? She had to get her emotions in check.

The month finally ended, and she celebrated with her friend Helen, a fellow medical resident. Their internship year was over. They were now officially second-year residents.

She and Helen both had a Sunday off before starting their new rotations and the new year on Monday. Sarah wished she had a full weekend like her resort weekend the month before. That seemed like a lifetime ago.

Not the murder, though. Sarah thought about that all the time. What if she’d had to tell her twenty-one-year-old’s mother that he was a murderer? Kidney disease was better.

Sarah and Helen had hardly seen each other over the past month because Helen had been in the ICU, the intensive care unit, with its notoriously difficult hours. Before that, Helen had been on the cardiology floor, so she had had two hard months in a row.

They met for lunch at an old Italian restaurant on Chestnut Street in the Marina. Chilly fingers of fog floated in from the Bay. Fog in San Francisco was not like the rare fog Sarah remembered growing up in Virginia. Fog there was thick and stationary, the typical pea soup type of fog. San Francisco fog was always in motion, swirling patches of fog here, billows of fog there, seeping, oozing, creeping through the atmosphere.

Sarah shivered. Fog horns sounded as she pulled open the door to the restaurant. Classic San Francisco weather for the end of June.

Helen was already seated and waved to her from a back table in the cozy restaurant. She looked as put together as always in a black turtleneck, her short blonde hair falling gracefully around her delicate features. Sarah pushed her own long hair out of her face, blown by the wind and moist from fog, never a good combination.

Sarah and Helen had met a year earlier, at the intern orientation picnic. Helen and her husband were from Boston, and Scott was finishing his PhD thesis in Japanese history from San Francisco, traveling back to the East Coast when needed. Helen had tried unsuccessfully to match into residency programs in Boston, so it was “because of her” that Scott had to complete his PhD long distance.

Scott was in Boston now. Sarah and Helen planned lunch and an afternoon movie in the old movie house down the street.

“Don’t get too full,” Helen said as Sarah sat. “Look what I made for the movie.” She pulled out a gallon-sized plastic baggy filled with caramel corn. “I have this great recipe, but Scott likes the stuff too much, so he won’t ever let me make it.”

Sarah laughed. Poor Scott struggled with his weight. Helen always had a big appetite, and now that she was pregnant, she ate constantly. She was still tiny, making her beach ball-like belly more obvious. The last time Sarah noticed, it was more like a basketball. When had she gotten so big?

Helen sniffed the bag. “I put extra peanuts in. My own special touch.”

“You know who would love this? Andy.” As soon as Sarah said his name, her heart jumped. Andy Middleton had moved into her building earlier that year and shared an apartment with his brother, Mike, down the hall from Sarah. Andy and Sarah started dating soon after they met. But, as Sarah had known almost from the beginning, a few months later he left on a yearlong journey to Asia to photograph elephants. He had taken a leave of absence from his job at the San Francisco Chronicle and had only been gone a few months. It seemed like forever. He was mostly out of cell phone range, and Sarah kept track of him through his brother and e-mail, and even that communication came in spurts.

“Andy loves caramel corn and he loves peanuts. And I wish he were here.” Sarah had always known he was leaving and tried not to get too attached to him, but every reminder was difficult. She couldn’t look at a picture of an elephant without Andy’s whole presence flooding back.

Helen nodded. “I made enough for him, too, I think.”

Sarah changed the subject. “I need to save some room. This place has such big portions, I’ll have to get a doggy bag.”

“Not me,” Helen said. “I’m starving.”

Sarah ordered spinach ravioli and Helen had lasagna, which came in a huge oval dish, large enough to feed two. She ate it all, along with salad, bread, and olive oil.

“I can’t believe you can eat all that,” Sarah said, breathing heavily after half a plate of ravioli. The bus boy started to take her plate away.

“If Scott were here, I’d get some of his bread, so can I have yours?” Helen asked.

“Have at it. I am stuffed,” Sarah said.

Helen reached over so quickly, she knocked over her water glass. “Oops. Sorry,” she giggled as the bus boy whipped out a towel and dried the table.

Sarah immediately thought of the little boy from the resort, kicking his water glass over. Somehow she imagined Helen and Scott there, bickering as badly as that little boy’s parents.

“How is Scott doing?” She was sorry immediately. Helen’s happy mood disappeared. She ducked her head and turned her face to the side.

“I don’t think he wants to be a father,” Helen said quietly, her face still turned. “Even after all this time. He never talks about it except to say how much things will change. For him. I know the brunt of the work will fall to Scott. And now…”

Helen’s voice trailed off. Sarah waited.

“We had a huge fight before he left,” was all Helen said.

“I’m so sorry.” Sarah took both Helen’s hands in hers. She thought of the little boy who sat in her arms so trustingly. She thought of Baby Owen, full of fun and joy.

“This is a baby,” she said. “A part of him. Of you. He’ll come around soon. This is one of the most wonderful, special times in your lives.”

Helen nodded slowly. “I feel like it is. I can only hope and pray Scott does too.”

The next day Sarah started an elective rotation, gastroenterology. Elective rotations were easy, easy hours, no overnight call, no weekend hours, no direct patient care responsibilities. She would even have a week of vacation, which she intended to take at home, sleeping in every day. She would work in the clinic with an attending physician, see his patients with him and follow him to the inpatient hospital wards as a consultant, not as the primary doctor of record. She had one elective in her internship year, pulmonary, and this was her second. The thought of an entire month of set hours and dinner at home instead of on the run at the hospital made her giddy.

And a little guilty. Helen was going from the ICU to the medicine wards, which Sarah had just finished. A third hard rotation. Poor Helen. She was saving her easy rotations for the end of her pregnancy.

Sarah liked gastroenterology, with its variety of diseases such as inflammatory bowel disease, hepatitis, and gastroesophageal reflux disease, all of which she saw her first day. She liked the attending doctor, an older man with a great sense of humor. He made the patients laugh, he made Sarah laugh, and he still seemed competent and caring.

Except with one patient who had pancreatic cancer and was not responding to chemotherapy. Her attending danced around the terrible prognosis even when the patient pushed him. Her attending didn’t look him in the eye but kept his gaze on the computer CT images in front of him. He left the room to get the patient’s printed prescription for pain medicine, and the man turned to Sarah.

“My wife has always wanted us to see the Taj Mahal. She says we need to go now. I’m still working, I feel fine. I think I have a few years left, and the doc hasn’t said otherwise. What do you think?”

Sarah looked right at him and told herself he hadn’t seen her blink back tears. She touched his arm and nodded toward the images on the screen. “I think you should see the Taj Mahal,” she said.

The man began to cry, as if he’d been holding on to these tears for so long they were ready to spill over unchecked now. “Why couldn’t the doc have told me that?” he said. “Why am I still working? She also wants to see the Great Wall of China. I told her someday we will. Will we?”

Sarah handed him the box of tissues. He blew his nose and wiped his eyes.

“You won’t feel as well in a few months,” Sarah said. “Someday is now.”

Sarah got home early her first night, before six, drained from this last patient. Her attending wasn’t drained, but she was.

She had known the boy was coming. She still came to a halt when she saw him in the lobby, the little boy with the blue eyes. Something about his eyes drew her in, and she couldn’t look away.

He gaped at her, his expression confused. Then he grabbed the dress of the woman he was with and screamed, “Mommmmmeeeee, Mommmmmeeeee!”

The woman bent and hugged the little boy, who was now crying. “Ben, Ben, shh, shh, it’s all right.” To Sarah, she said, “I’m so sorry. He’s been through a lot.”

Sarah didn’t know what to say. Should she tell this woman she knew who the boy was, knew about what happened? Should she slink away and not cause the boy more pain? She didn’t have time to decide because the elevator door opened with a ding, and Enid Carmichael strode out, her fidgety dog in her arms.

“Sarah,” she shouted from across the lobby, “perfect timing.” She motioned for Sarah to come over. As Sarah got close, she whispered, again loudly, “This is that boy you know. From the newspaper. And his grandmother. Maybe you can introduce me?”

Sarah glanced back at the boy and his grandmother, embarrassed. They had clearly heard every word.

Sarah stepped toward the woman. “I met your son and his family on vacation, down in Big Sur. I think this little guy might recognize me.”

“Oh, my,” the woman said. “I was there too. I don’t remember you. I’m Julia Blackwell.”

“You were there?” Sarah said. “I didn’t see you either. I was only there for the weekend.”

“Oh, I came after that. My son called and asked me to come and help out with Ben. He wanted some time alone with his wife. I suppose you met her too?”

Before Sarah could answer, Mrs. Carmichael stepped in, her leathery hand extended. “I’m Enid Carmichael. A friend of Frances Noonan’s. I’d be happy to help out…” She peered down at Ben. “I’m not good with kids. Anything else, though, you just let me know.”

“Thank you, that’s very kind.” Julia Blackwell leaned and took Ben’s hand. “It’s getting late for us. We need to go now. Very nice to meet you.”

Before the door closed behind them, Mrs. Carmichael bellowed, “So, that’s the murderer’s mother, huh?”