by Kate Ledger
“Nope.”
“Maybe you could—”
“G’night. I’m going to sleep now.”
“Well, I just wanted to say I’m back.”
She just looked at him. That was it. No more. It was all the welcome he could have hoped for. All he cared to hear was that the idea of the wine kit had intrigued her and that she was on his side, after all.
He made his way down the darkened hall. Sitting on their bed, he watched his wife sleeping, wondering if he could wake her. Her shoulder jutted protectively; the strap of the eye mask hugged the back of her head. As he leaned over to kiss her hair, she rolled flat onto her stomach. In her deep breaths, he heard the sound of his loneliness, matter-of-fact and elusive and impossible to describe. Lamentable, he thought again.
At work the next morning, which was Friday, he had a mission. He set Julie McKinley to do the detective work, finding anything she could on the drug. “Sulmenamine, S-U-L-M,” he directed. “Write it down. Go through all the drug books we have. Look up ‘syncope,’ fainting, drugs of the Old South. Whatever you need to do.”
But an hour later she reappeared, having turned up nothing. “Are you sure it’s not S-U-L-E?” she asked. “Or maybe there’s some other variation?”
He fished the vial out of his pocket and squinted at the print. “S-U-L-M.”
She narrowed her little eyes. “Why am I doing this, exactly? I mean, what’s the goal?”
“It’s not available through the pharmacy. I want to know what it is, what it’s for.”
“And then what?”
He looked at her. “Intellectual curiosity. Isn’t that enough?” She didn’t reply. “I’ll take care of it myself. You can take these instead.” He handed her a stack of folders. “It’s about my father, if you want to know. I discovered that he’s taking it, and I want to know what for.”
“Fine, I’ll do it,” she said.
The edge in her voice surprised him, though he realized she’d been sulky since he’d been back.
He lowered his voice. “This isn’t about what happened before, I hope. I tried to explain.”
“I know,” she said evenly. Her chin was high. He noticed again the unnatural texture of the foundation on her cheeks. It did not hide the ancient pitting. His stomach turned at the thought of having kissed her. What had he been thinking? That was it, he hadn’t been thinking. He’d simply acted, and it had been exactly the wrong action.
He said, “I told you, it was unexpected. I shouldn’t have done what I did.”
“It’s not that.” She looked at him and then away.
“Then what’s the problem?” he asked.
“It’s that patient Maxi Bailey.”
“Yeah?” he prompted when she didn’t continue.
“Well, you were practically throwing narcotics at her.”
He stared at her. “I was coming up with a solution.”
“I was trained to watch out for that. To watch out for people who overprescribe narcotics. When there are a whole bunch of things that might be wrong with her. When she might be one of those people who just wants the drugs. I studied it.”
“Is that so?” He was testy.
“She could be treated for depression, for instance.”
“Of course she’s depressed.” A fleck of spit flew from his lip in an emphatic arc. “Pain is depressing. Not being able to participate in her life, that’s depressing. When the burden of her pain is lifted, and she can enjoy what’s around her, she’ll feel better about everything.”
He left the room to see another patient. But he couldn’t worry about Julie’s attitude or her overly traditional training. She’d have to get on-board with his philosophy if she wanted to be part of his practice. She’d have to learn that it was important to keep thinking of ways to improve treatment—and that it was important, no, essential, to listen to the patients above everything else. That was the cornerstone of his practice. He refused to be sidetracked by her doubts.
His best shot, he realized, was Ted Ebberly. He dialed Ted’s lab at the medical school. The Bears and the Ebberlys had met years ago through a mutual acquaintance, Vera Bidgel, a retired physician whom Simon had known during his training. The two couples had known each other casually—or known of each other—but it was not until Vera was dying of breast cancer that they’d cemented a kind of friendship, running into each other in the hospital, swapping updates about her condition, admiring each other for having made what was the most difficult and awkward of social calls. After Vera was gone, the friendship persisted, something fortunate that endured out of all that dying. It was Betsy who would say from time to time, “I’ll always remember how good you were to Vera at the end.” Or she would say, “Vera was lucky to have you.” Simon’s answer to her always was, “She was lucky to have all of us,” because in his mind all he’d done was show up, generate a little conversation. But he was pleased to be remembered for kindness, and he felt Betsy had something important to teach him—and everyone—for making a person feel good about the very little he’d been able to do. What he appreciated about the friendship with the Ebberlys was that it had begun in their earnest attempts to be their best selves.
Ted seemed happy to hear his voice. “Simon! I’ve been meaning to call. Betsy and I w-want to try out that new restaurant in Canton. H-how about we make an evening of it?”
“Suggest a weekend and I’ll check with Emily,” he said. “Ted, got a question for you. Ever heard of a compound called sulmenamine?”
“Nope. S-spell it f-for me.”
Simon spelled. “Really, I’ve no clue about it. I came across it and I’m trying to figure out what it is, where it’s from.”
“Context?”
“A patient. Someone’s taking it. I can’t get any information about it.”
“Gimme some more clues,” he urged. Simon could hear that the stammer was gone.
“I don’t have many. It’s in formulation. Two percent. Liquid. Injectable. It’s not currently in common use, I know that much. But what’s the compound? What does it do?”
“You need a pharmacist,” Ted suggested.
“I tried one, got nowhere.”
Ted paused. “I’m having lunch with the chairman of pharmacology next week. I can ask him then.”
“I can’t wait that long. Any chance you can call today?”
“I’d like to, but I’ve got back-to-back meetings all afternoon.”
“It’s not just idle curiosity, you know. My father was in a car accident earlier this week.”
“I hadn’t heard,” Ted said. “I’m sorry.” Simon couldn’t help appreciating the sympathy, at the same time feeling stung that Emily hadn’t mentioned the event to Betsy. Or maybe she’d mentioned it to Betsy, who’d then neglected to pass the information along.
Simon described how his father had totaled the car. “But he’s doing well. Anyway, it’s his drug. I need to know everything I can about it.”
Ted exhaled. “I can try to call over to the office, see if I can get a quick answer. Sulmenamide, you said?”
“Sulmenamine,” he corrected. “See?” Julie lifted her head as he hung up, and he slapped his hand on the desk with satisfaction. “That’s how you get things done! He’s calling the chairman of pharmacology, and we’ll have an answer in an hour.”
Rita appeared in the doorway of the office. “Can you take a pain patient?”
“Who ya got?” Simon was back in a sporting mood.
“Jim Weaver.”
“Ah.” He signaled to Julie to follow him.
On principle, as his whole staff knew, he fit them into his routine, no matter how packed the schedule. Furthermore, he liked Jim Weaver, who was sixty-four, with a shock of white hair and a perpetual stubble that covered his chin like the first frost. He was an amputee, the result of an accident, and since losing his arm he’d had the bearing of a man who’d lost incentive to believe in his good looks. His eyes stared dolefully from beneath whitened brows, and his cheeks were
slackening into jowls. The left plaid sleeve, rolled up, had been pinned just under the stump below his shoulder, and he walked with it twisted forward slightly as though he were protecting it from bumping into anything.
“I had to wheedle my way in here,” he said as Simon entered the exam suite. He spoke in little gasps. “I couldn’t wait another day.”
“Gotten worse lately?” Simon asked him, rolling a stool close.
“Excruciating.” His face contorted with the word, and his shoulders crimped, spine twisted forward.
“One of the greatest mysteries of the neurological system.” Simon turned to Julie, who had followed him, and then he remembered to make an introduction. “This is Julie. She’s my new star pupil. Tell her where it hurts.”
“My arm,” Jim said, then redirected her as she looked at the hand that gripped the edge of the exam table. “No, this one. The one that’s gone.”
“Phantom pain?” Julie murmured. “I’ve heard of that.”
Simon urged, “Tell her how you lost your arm.”
Jim Weaver grimaced again. “An accident with a circular saw. Lost my grip.” He cracked a smile, showing a single row of teeth. “Figuratively, and then literally.”
“It had to be amputated just below the shoulder, but in many ways, he’s still living with it,” Simon said.
They stared at the air underneath the pinned sleeve. “I know exactly where it is in space,” Jim Weaver said in his tinny, breathy voice. “It’s gone but not gone. You know how you can close your eyes and put your arm in the air and know where your hand is in relation to your body? I know where the missing arm is, its position, you know? It takes up as much room as it used to, and I’m conscious of it in the same way. The trouble with the missing arm is that I can’t move it. It’s like my fingers are curled over the thumb and the wrist is curled under. The tension is unbearable, and there’s no release.”
Jim shifted his torso, and the pinned sleeve waggled. They looked where the arm should have been. In sympathy, they became aware of its absent contours, and the knot of fingers that didn’t exist and were thus impossible to disentangle. They looked and they were aware of it, but the arm was not there. The shoulder nudged forward, and the fabric of his shirt shifted. In the space where they looked, they could see straight across the room to the eye chart on the back of the door.
“Haven’t you been to many doctors?” Simon asked.
“It gets embarrassing after a while,” he admitted, “going on about something that you can’t touch, you can’t show anyone. You start to sound like a lunatic, even to yourself.”
“Anyone you go to will tell you it’s a real phenomenon,” Simon said, “but nobody’s quite sure what to do about it. Phantom pain can go on for years after an injury. We tried narcotics, but they didn’t do much for you, did they?”
Jim Weaver cupped his present hand beneath the stump, without quite touching it. “It burns.”
“They used to do cordotomy for that,” Simon said. “Cut the nerves in the spinal pathway. The theory was that there were overexcited nerve endings feeding errant messages into the dorsal horns on the spinal cord. The solution? Sever the spinothalamic pathways leading to the brain.” His voice rose as though he meant to impress upon them the ridiculousness of the procedure. “But they couldn’t keep the pain from coming back. So where’s the pain? The arm is gone, and so are the nerves in it. The message route from the injury to the brain has been severed, but patients are still in agony. Somewhere between the spine and the brain, there’s a leak of information. The signal’s still getting through.”
Jim shook his head, sucked his breath in. He wiped his forehead with the crook of the good arm. “I’ve been considering that other procedure, the one the neurosurgeon suggested, where they burn the nerves, but I’m scared.”
Simon nodded. “The dorsal root lesioning? It’s dangerous, all right. They go into the cervical spine and burn or freeze out the nociceptive cells that are misfiring. Sure,” Simon agreed, “it’s like tossing a hand grenade when you need a sharpshooter. They have to hope they hit nerve cells and not motor cells. He could wind up paralyzed.”
“We tried a therapy last time I was here,” Jim ventured tentatively, as if he’d suddenly gone shy. “It worked for a while. I want to try again.”
“Right,” Simon said. “We gave you shots of saline—that simple—right below your shoulder. It’s the absolute best noninvasive therapy there is for this kind of pain. Kind of a miracle therapy. Works wonders. I do it all the time. Happy to give it another go.”
“And there was a cream you used,” Jim Weaver reminded him.
Simon nodded gravely. “Ah yes. I’ll get Rita to prepare that, too.” He led Julie out of the room, and he instructed Gabi to prepare the injections.
When Julie spoke to him, her voice was almost a screech. “Saline?” She spun around and stomped.
“Fascinating, isn’t it? Here’s a man with no limb, and yet it hurts as if it were still there.”
“You’re giving him saline? How long does that work?”
He lowered his voice. “I’m not convinced it does. And unfortunately it hurts, too. I read about it in a book of therapies from the nineteen hundreds. Hypertonic saline injections, isn’t that wild?”
“Are you kidding?” She looked at him like he was crazy.
“Nope. You give a mild ache to someone with pathological pain, and sometimes it manages to mask the larger problem. Who knows why it works? Maybe like a distraction, like pinching a kid so they don’t feel a tooth being pulled. There were studies that suggested it might actually raise the pain threshold overall. But Jim believed it worked last time, so in my book, it’s worth doing again.”
Julie’s mouth fell open. “But this is like before,” she started, “with that patient Maxi Bailey! You’re not giving him a cure. It’s just like a Band-Aid.”
He moved his body between her and the exam suites, and he lowered his head toward hers. “Keep your voice down,” he grumbled. “I don’t know if anyone has a cure. I certainly haven’t seen one. The most important thing is to have something to offer. And it’s essential to be enthusiastic—as much as you can. Skepticism does nothing for patients.”
She put her hands on her hips. He could see the boniness of her arms. “So you’re deceiving them?”
With a grip on her knobby elbow, he pulled her into his office. She stumbled against being yanked. “I’m not deceiving anybody!” he said when they were alone in his office. She crossed her arms and looked at him sullenly, but he didn’t respond to her expression. “I’m giving hope. Know what the most powerful curative agent is? The mind. Do you have any idea what the efficacy rate is for placebos? Over thirty percent. They’ve seen placebos lower blood pressure and improve the immune system. Sugar pills have been known to cure kidney disease. It’s not just wishful thinking, it’s employing the body’s most central, most powerful resource.”
She lowered the lids of her eyes, as her whole face closed like a purse, and looked away. Was she for real? He was so surprised by her outburst, by her contrariness. Everything had been going so well. He wondered if her issue was about that other thing that had happened, the kiss that was a fluke. It was an accident. She’d said okay, as if she’d understood, and he’d believed her. He hadn’t meant to do it, and she’d acknowledged, and they’d agreed it was over.
“What’s the cream?” she wanted to know.
“Just something to soothe the skin.”
She rubbed her elbow, looking at him in disbelief.
“You look mortified,” he said, thunderstruck. “I’m telling you, I know what I’m doing. There’s nothing deceptive here. Most important is to provide an option. Something to try. And know what? Sometimes it works. I’ve even given people dry injections. Nothing. Just a poke, moving the needle in and out of the part that hurts. Don’t look so stunned. I didn’t make these treatments up. I found them in medical texts. Some of them have been abandoned, but sometimes you find they work.
”
Her voice was almost a whisper, as though she hesitated to say the words out loud. “You just . . . poke them?” she asked.
“Nothing deceptive,” he said again, with great exasperation. “I don’t pretend to give one treatment and then give them something different. That’d be deceptive. I give them a complete record of what transpired during their visit, right? It’s just that I’m willing to try therapies—even strange-sounding ones—when other doctors would throw up their hands and walk away. And I’m willing to let the patients determine what they need. They’re the ones who guide me. One thing you have to learn about medicine is, if a patient believes something is going to help them, it probably can.” He looked up to see Rita starting down the hall, and he halted the conversation because he didn’t want it to look like they were discussing anything private. His hackles were raised to be challenged, that was all. He hadn’t anticipated being second-guessed. “Did Ted Ebberly call?” he asked.
“Not since I’ve been here,” she sang out.
“I’m expecting vital information from him,” he informed her.
He turned back to Julie, but she was not looking at him. He stalked out to the exam room to give Jim Weaver the treatment. But he was not his best as he delivered it. Lifting the saline-filled syringe, his hand shook, an almost imperceptible quake. She’d rattled him. He turned his wrist quickly to hide the tremor, but he felt it, and he felt certain Jim Weaver must have noticed it. Julie had not accompanied him to see the treatment, and her decision not to follow him into the room also had unnerved him. She was young, he reminded himself, and her inexperience made her believe that medical journals were more real than people. But you couldn’t treat human beings if you followed the texts like a recipe book. If you learned to listen to their voices, to everything they were telling you, if you learned to see with your own eyes, you’d know more than you’d ever learn from taking a class about a condition. She would come to understand, just as he had come to understand, that the point of a medical career was not to protect people from themselves, but to be as useful as possible in whatever way.