Remedies

by Kate Ledger

  “Come in, come in!” he said, though she’d already entered. “We have a place for your things.”

  He led her around the corner of the reception area to a walk-in closet reserved for the staff. As he stood next to her, he realized for the first time how little she was, only about a head taller than Jamie. He felt a rush of pride—and relief—as he realized he didn’t want to sleep with her. Sex was certainly not the reason he’d hired her. If the topic had come up with Emily, he could have said with grave honesty that he wasn’t attracted to Julie McKinley, but Emily wasn’t jealous of other women in that way.

  Julie tucked her backpack onto a waist-high shelf in the closet. Her body was concertedly, even unreasonably thin, her cheeks feathered over with a chalky foundation meant to hide the pitting from adolescent acne. All of the details suggested, endearingly, he thought, a person intent on trying hard. He’d gathered that about her from the interview, as she sat with her shoulders squared in the chair opposite his desk, wearing a dark blue suit with a skirt and a choker of pearls too large to be real. The assessment had made him all the more eager to explain how he’d started the practice from scratch and had built a reputation in the most respectable way possible: by word of mouth. Wives now brought their husbands to see him, neighbors passed his name along to their friends, and physicians referred their mothers-in-law. He had produced evidence, displaying for Julie the file he kept of gushing, grateful cards patients had sent to the office. On his wall and on his bookshelves were gifts they’d brought back from their vacations, a silk fan from China, a fertility statue from Mozambique, a pyramid-shaped bottle—still unopened—of agave tequila from Mexico. He ate free at every Dora’s Café in town because he’d suspected—correctly, it turned out, and in contradiction of an eminent doctor in town—that the general “weird” feeling that one of Dora’s aunts was having wasn’t simply nerves or indigestion but a slowly evolving stroke. He was respected by the medical community, by internists like himself, and by the specialists to whom he referred his most difficult cases. Twice, he’d been on the list of Baltimore Magazine’s Top Docs. The glossy clips were mounted and framed and hung side by side in each of the three exam suites.

  Throughout the interview, he’d hoped she was impressed by his practice and that word would get back to the dean. Then he’d noticed the pearls and had realized he wanted to help her. “If I get this job,” she’d gushed, “it’ll be the best day of my life.” She’d grown up in Towson, just across the county line from Baltimore, with a single mother who worked several jobs to keep the family afloat. To put herself through nursing school she’d waited tables and tended other people’s children, and she’d taken more time than most students to finish the coursework, but her grades were solid and she’d won the Torrence Nursing Award, the most promising graduate in her class. All her life, she’d been waiting to move out and live on her own, have a salary and a steady job and the means to make significant decisions about her life. If he hired her, she stated, it would be the day she proved she was going to make something of herself. “Have made something of myself,” she restated. The phrase caught him off guard, and for a second he thought he might laugh, just at the guileless way she continued to nod. Emily would have rolled her eyes at that point—the young nurse had no idea how to present herself. But Simon had the opposite response to Julie’s honesty. What Julie wanted was a mentor, someone to guide her to the next phase of her career. It was within his power to be that, and so he offered her a job. The impulse made him feel as expansive as a wide-winged bird. He was not far from trying to press a wad of bills into her hand.

  Now, standing in the waiting room, she looked around, taking it all in with the look of a person marveling over an inheritance. “Such an incredible space,” she commented. “It’s so awesome how the waiting room doesn’t look like a waiting room. It’s like—like a czar’s salon.”

  He was amazed by how much she reminded him of his daughter. But he looked appreciatively at the deep russets and forest hues of the walls and drapery, the chairs edged with gold, the cushions trimmed with elegant paisleys, and the detailed woodwork that had been added at great expense and trimmed with light blue and gold paint. “That’s my wife’s brilliance,” Simon said with unreserved enthusiasm, glad for the opportunity to mention Emily. “She’s smart about these things. Most doctors don’t sink a lot of money into the waiting room, but where do patients spend the most time?”

  “Who did the ceiling?”

  Simon looked up. Above them, a painter’s fine detail work had created an overarching canopy of branches, small leaves fluttering, and beyond them, sky.

  “Can’t remember the guy’s name,” Simon said. “Local artist. The ceiling was my idea. I have to admit, trees wasn’t what I had in mind.”

  “It’s peaceful.”

  “I wanted a replica of the Sistine Chapel,” Simon confided. “We went to Florence when we were first married, and the ceiling just blew me away, the creation of man, God about to touch Adam’s hand. A bunch of rosy angels watching. You know that outstretched arm? It seemed like something that would be unusual, absolutely bold. My wife said, ‘Whoa.’ A million reasons, no. She didn’t think it sent the right message.” Actually, Emily had argued against the painting because she said it would give the impression (to patients) that Simon thought he was God. Nothing could be further from the truth, he argued. If anything, he thought the painting, in a medical setting, suggested that everyone was ultimately equal, all created by the same divine touch, every last human indebted to a higher power, God or something else. More than a decade ago, they’d gone around and around on it.

  “And besides that, my wife said, ‘What are two Jews doing with the Sistine Chapel on their ceiling?’ I said, ‘It’s art.’ It’s not a religious thing. Anyway, we’re not even that religious,” he added guardedly, then wondered aloud, “You Jewish?”

  He knew she wasn’t—the name McKinley, for chrissake—but he often asked when he met someone new and sometimes found himself taken by surprise. (Years ago, he’d had a receptionist named Candice who’d grown up in the county and who admitted to him that he was the first Jew she’d ever met. It blew his mind. Baltimore! Where’d she been? He hadn’t been able to forget that fact about her, or let it go. “So now what do you think of us?” he’d chided Candice after she’d worked in the office for a month. He badgered, “Are we what you thought?” Her face blanched, but he wouldn’t relent. “I gotta know if I’m doing right by my people,” he teased. Finally, she waved him off, saying, “I meant the other kind of Jews. You know what I mean.” He tried, but he’d never been able to needle an explanation out of her, and eventually she left the office for another job.)

  “We’re Jewish, but not that Jewish,” he continued with a wave of his hand. “We belong to a temple on Park Heights. It’s Reform. Mostly a social thing when you get down to it. We go only on High Holy Days.” He looked up at the ceiling again. “Anyway, we hired an artist to paint this natural scene, as museumlike as he could. Complements the furniture in an interesting way, I think,” he said, his hands on his hips as he considered the space above, still able to imagine the painting that hadn’t happened.

  But Julie McKinley was looking downward. “Cool fish,” she said.

  “The pond was my idea,” he bragged. Between the large paisley-covered chairs, a section of the waiting area was carved to include a fountain, ringed with stones, and a small waterfall. Below, in the water, four lank orange and white fish sidled alongside one another, still, but seemingly listening, as if they awaited a command. “My wife was skeptical but I wanted the biggest one we could build in this space. My wife’s a genius about public relations, partner of a company in Bethesda, you heard of Frith International? Even she had to agree the indoor pond was an inspired idea. I wanted it for the calming effect, but it turned out to be a great way to make the practice stand out in patients’ minds.”

  “They’re like goldfish, but big.”

  “Japanese koi,”
Simon corrected. The water rippled as a pipe-thick fish slunk sideways and then resumed its motionless vigil. Julie stepped to the edge of the rocks and watched. “Certain varieties of them cost thousands of dollars. I collect them.”

  Suddenly impatient, Simon turned and walked back to the reception desk. “Let’s get you oriented,” he said. “We open in twenty minutes.”

  “You can show me where you keep supplies so I don’t have to keep asking all day,” she suggested, and he heard Emily’s voice in his head again, reprimanding.

  They walked down the hall, passing exam suites A, B and C, to his office. Why had he asked her to come early? It wasn’t to preview the filing system. He wanted to describe to her how he thought about things. In truth, he considered his own history as someone who’d made something of himself, even though his parents were educated and hardly down-and-out. He’d fashioned a career according to his own vision. His father, Charles Bear, had made a pretty penny in real estate. After returning from a tour of duty with the Marines in the early 1960s, in which he was responsible for rescuing a hijacked passenger vessel in the Atlantic, Charles had invested in a small area of land and built a putt-putt range south of Baltimore. Small, recreational and unassuming. The unassuming part was the key to his success because the county government overlooked him, the developers left him alone. For years, like a frontier squatter, Charles had purchased plots of land adjacent to the range, quietly expanding until he owned a vast valley in Montgomery County. Then he established a golf course and a country club, which he’d managed into the mid-1990s, until he sold it and moved with Simon’s mother, Lucille, to Florida. She was college-educated, though she’d been a homemaker all the years Simon was growing up.

  He’d been aware for all of his life that his parents represented a successful unit, that Charles’s strategizing had ensured money was a nonissue, that Lucille’s duty to her husband had given the marriage a rare, if idiosyncratic, integrity. But he’d known since he was small that he was different from them. Charles had made his life about getting—and what was the quote? Simon read it in college and the words stuck as they hit grave understanding: “Getting and spending, we lay waste our powers.” His mother’s domesticity was a ritual of obsequiousness, an impotent, underachieving method of serving his father. Neither of his parents had set out, as he had, to improve the world and to save lives. Now there was putting one’s powers to use. Even as a teenager, Simon had been drawn to the idea of healing other people, easing their hardships. He’d committed himself to that goal. And then, years ago, when he and Emily had been beset by their own tragedy, he’d stayed the course. At that moment, everything might have changed for him. Another doctor, another kind of man, a father who’d lost a son, might have given up on a life that was burdened by other people’s problems. Caleb had been all of six weeks, a pale and squirming starfish, and the fact of his death had been a sucker punch in the belly. But Simon had rededicated himself to his ideals, continued to see patients, persisted in his effort to do good, trying to help. He’d overcome Caleb’s death the best way he knew how, by investing in what was noble and right about his career.

  “This is no ordinary private practice,” he informed Julie McKinley. “In a ten-mile radius of my office, you can find excellent physicians of all kinds, but no one thinks about medicine the way I do. That is, really thinks about it. People don’t consider all the changes that can make things better, easier, more effective. I think about the world that way. I’ve made dozens of innovations.”

  Julie McKinley bobbed her head.

  The pieces of Simon’s prepared speech flowed to him. He had so much to impart, there were so many facets to it, but it all came down to one thing. “My mission is to point patients toward whatever will help them. Period. That’s most of what you need to know. I’ve found terrible flaws in how most physicians practice,” he stated. “And I’ll be damned if I repeat those mistakes with my own patients.”

  Julie’s small eyes squinted at him. “What do you mean ‘flaws’?”

  “Ha. Good question,” Simon answered, perhaps a little too loudly as Julie McKinley jolted a tiny bit in surprise, and then resumed her agreeable nodding. “Most doctors wouldn’t even acknowledge that flaws exist. But I’ve thought about things. I’ve considered what happens in the doctor’s office. I’ve discovered some of what we do could use a little tweaking.”

  “Like?” Julie said.

  He led Julie back down the hall to a cabinet. “Every patient leaves with one of these.” He handed her a blue folder, the kind with interior pockets. On the cover was a profile of a foraging grizzly embossed in gold foil.

  “Oh, Bear, I get it.” She fingered the illustration. “Pretty.”

  She really was like a child. But he would not change his mind now. If Emily were to challenge him, he’d assure her that he’d take responsibility for Julie. He’d make the decision work. “Every patient gets a write-up of what happens during the appointment,” he explained. “When I first started practicing medicine, I found patients saying yes, yes, yes, while I was talking with them, but after they got home, they didn’t understand, or plain couldn’t remember all of what we’d said. They’d asked a question but only held on to part of the answer. Or they’d say, ‘Yeah, the doctor says it’s my iliotibial band,’ and they’d have nothing in front of them to help them look it up. So, no more. Patients leave with the information they came in for right in their hands. Even little questions. And not like a scrap of paper like some doctors who scribble on a paper towel or whatever’s handy. Sometimes the nursing staff complains about the extra paperwork, but that’s how I have a top practice.”

  “It’s a good idea,” Julie acknowledged.

  “That’s how I see my job. To come up with good ideas. I was warned against casually handing out records to patients. A doctor I met on a plane years ago told me it’d open me up to all kinds of litigious problems. ‘Certain kinds of patients are bloodthirsty,’ he said. ‘Records that float around are bound to work against the doctor in the end.’ But I don’t see it that way. People who’re treated well—pampered by a doctor who’s visibly doing everything on their behalf—aren’t inclined to sue. People sue when they feel their needs aren’t being taken seriously. When they feel small. Suing is the very primitive urge to be heard. The typical interaction between a patient and a doctor—guess how long? It was in a prestigious medical journal. Seven minutes. If you can believe it,” he emphasized. “That’s reimbursement, overbooked schedules, whatever. But doctors who spend four minutes longer with patients get sued twenty percent less.”

  “Maybe they’re less rushed,” Julie suggested. “Four minutes longer and they make fewer hasty judgments. In nursing school, we—”

  “No,” Simon interrupted. “It’s not the work, it’s the tenor of the interaction. It’s that patients have the perception, in eleven minutes versus seven, that a different sort of encounter has taken place. Four more minutes and they feel somebody’s taken the time to listen. I’m not worried about giving patients precious documents. I’ve been giving patients write-ups of their appointments for almost a decade, and I haven’t been sued yet.”

  They both turned their heads as a key jiggled in the front door of the practice. Simon stepped forward and pulled it open as Rita Golodkin, rotund and huffing, wearing a purple dress with splashes of color, tried to snatch back the key ring that swung away from her.

  “Everyone’s early today,” Simon said with obvious pleasure.

  “You startled me,” Rita said, stepping into the office. She was older than Simon, motherly, with a dandelion halo of pewter-colored hair. Large hipped, she brought to mind the shape of a Russian nesting doll. She mopped her bright and jowly face with a paper napkin. “What’re you doing in?”

  “Julie’s first day. I’m orienting her to the ways of our world,” Simon said.

  “Our little world,” Rita echoed, depositing a large purse on the reception desk. “Well, welcome. He’ll talk your ear off. But he’s also th
e nicest person you’ll ever work for. Biggest heart ever. He really cares.”

  “Rita’s been here almost as long as the practice has been open,” Simon said. “Seventeen years. She even served as a subject when I developed the Boardwalk Diet. Did you hear about that? It was in the paper.”

  “It worked,” Rita attested. “He had a lot of critics, but it was a good plan.”

  “It required the right kind of patient,” Simon said. “See? That’s another problem with medicine. People think a treatment is only good if it works for all people. But each person is different, and you can’t write off potentially helpful treatments just because they’re not right for everybody.”

  “What’s the Boardwalk Diet?” Julie asked.

  “Watch out,” Rita warned, jesting. “You’ll get him started.”

  “The theory behind that diet,” Simon explained, “was that some people have what I call problem foods. That’s foods—or food groups—they can’t resist. The source of their excessive, unwanted weight.”

  “Mine was chocolate,” Rita confessed. “Sweets in general, but chocolate in particular. You couldn’t keep me away from it. I had truffles in my nightstand, Hershey bars next to the shower. Sometimes I had chocolate before breakfast, and I couldn’t stop myself, either. If I ate one chocolate doughnut, I wanted all of them.”

  Julie looked back and forth between them as though she wasn’t sure if they were pulling her leg, but Simon recalled the background of his inspiration.

  “One summer when I was a teenager, I worked in a fudge shop in Atlantic City,” he explained. “You know, on the Boardwalk. At the shop, you were allowed to eat as much fudge as you wanted, no holds barred. So I did. The first week, stuffed myself silly with fudge, practically made myself sick, and you know what? I was around it all summer, and I never wanted another taste of it. Still don’t care for fudge very much. Anyway, that was the idea behind the diet. I got to thinking about foods and people’s indulgences, and I realized that if you put people on a regimen where they’re forced to eat to the point of discomfort, where the very problem foods bring up negative associations and negative physical feelings, that they’d actually lose the desire to overindulge and you could eliminate some of the most troubling sources.”