by Kate Ledger
“I thought it was flu,” Emily began. Her voice came out thick, as if warning of the danger of reading too much into her words. “She was feverish, you know? She slept a lot during the weekend. She was sick, remember, before you left, but she seemed okay. Grumpy, but okay. I took her to—I took her to the new apartment. With me. I didn’t tell her.” She chewed the side of her lip, looking momentarily vulnerable, he thought. Was she daring him to get angry? He felt too numb to muster a response. “She slept in the car, and she slept once we got there. I made sure she ate. She slept, then she got up. She was shaking, and she wasn’t making any sense. Just jabbering. Like another language.” Emily’s voice broke, and he could picture the apartment, and Emily taking care, and then the moment of terror. The taste in his mouth was as wrong as a penny. “Like she was speaking in tongues. I couldn’t understand a word, and I panicked. I didn’t know what else to do. I called the doctor, and he said get her to an emergency room.”
He listened, and for a moment, he discovered the urge to stand up, walk around the bed and fold her in his arms. He wanted to comfort her, but he was afraid that an embrace was exactly what she wouldn’t want from him and he dreaded being denied. Instead, he remained still, holding Jamie’s hand, gazing at her light fingers, imagining the way the wind would wrestle with such a leaf.
“She had a temperature of a hundred and five. They got her here immediately. They said it was the thing she did to herself—the piercing. She did it so long ago, I had no idea it could turn bad after so much time. Cellulitis, they said. The infection started on her skin and spread through her whole system.”
He was thinking of porpoises. Sleek bodies arcing over the water as they hunted in small groups. He’d read a magazine article. They were shy of people, but for some reason, they didn’t stick together well as a group. They got stranded easily. Well-meaning conservationists tried to help, but the worst thing for a stranded harbor porpoise, it turned out, was a human-built aquarium. He looked up and realized that Emily was staring at him. She had paused, and her face was mottled, and he wasn’t sure how long he had been silent. But she looked more stricken than threatening as she implored, “Say something. Aren’t you going to say anything?”
Emily wanted to stay on at the hospital. He offered to take over so that she could go home to sleep for a few hours, but she didn’t want to leave. He fought her, until he decided the best way to win her respect would be to come back later. Plus, it was awkward. There was that ugliness hanging over them, the resolute cracking of that perfect egg, their marriage, which they’d managed so deftly for so long, running with two legs tied together as they balanced it on a spoon between them. There would be financial negotiations—crack!—arrangements involving the other apartment—crack!—a flurry of phone calls and legal consultations and a million details breaking all of it apart. They managed to keep the tense conversations away from Jamie’s bedside, talking in the hallway, but it became clear, as each new conversation ran amok, that the best plan would be to split attendance at the hospital.
“How was your conference?” she asked. She might have been making conversation, but he presumed she was asking to underscore her annoyance that he’d been out of town when the crisis evolved.
When he wondered aloud, “Are all your clothes at your new place?” she presumed he was accusing her of callousness.
When she asked, “You presented the treatment?” he was certain she was mocking him.
And then when he queried, “Are you sure you want to stay overnight?” she took offense; did he think she wouldn’t?
What they didn’t discuss were the details of Jamie’s piercing, what either of them had known or not known, said or not said. It wasn’t clear which would be more culpable. He suspected guiltily that Jamie had been bored and that her boredom was his fault since she’d languished all summer with no plans, no desires, no other kids to hang out with. The wine kit, he realized, must have stood out for her as the first potential activity in months, and he’d dangled it in front of her and then summarily postponed it. He hadn’t known that she’d entertained herself alone in the house, jabbing herself with a hooked suture needle that evidently had been pilfered from his office. It helped, he realized as Jamie awoke, to count on her illness to occupy them.
“Hi,” Emily said softly, leaning onto her side of the hospital bed.
“We’re here,” Simon said, edging close on the other side and taking her hand.
“Let me get in there a sec.” A nurse reached over to adjust the IV, and Simon leaned back.
“How do you feel?” Emily asked. “Can we get you anything?”
Jamie opened her mouth. “I’m thirsty,” she answered in a whisper. “My mouth’s all dry.”
Simon turned to the nurse. “Can we have water, please?”
“She needs a sponge for her lips,” Emily said.
“I’m sleepy,” Jamie said with a small smile.
“You’re pretty sick, little porpoise,” Simon said. “You got a pretty good infection.”
“I know,” she said, sounding pleased.
A new doctor rounded in the late afternoon, explaining that the admitting physician, Dr. Baumgarten, had left for the holiday.
“What holiday?” Simon asked, annoyed. He had lost sense of the date, would have had to think to recall the day of the week.
“Um, Roshashawna?” the new doctor suggested with an apologetic shrug. “I think?”
“Right,” Simon answered. September always sneaked up on him like that. Labor Day was starkly marked and widely observed, but then the Jewish new year arrived on tiptoe. In recent years, it was always too late by the time he realized they didn’t have tickets to services. And he always considered the holidays a pair; if you missed the new year celebration, it seemed the height of hypocrisy to hop in ten days later for Yom Kippur.
He looked at his wife. They hadn’t decided finally on the arrangements, what the bedside schedule would be. Simon had canceled his Monday appointments because of the conference, so he was in no rush to get back to Baltimore. It made sense, he pointed out, for him to stay with Jamie through the night. He’d have to go back in the morning to see patients, but then he could come back after work and do the night shift again.
“I’m here now,” Emily said. “I’ll stay tonight.”
“Why don’t you get some rest?”
The slightest shadow of annoyance crossed her face, and he realized he should let her take charge.
“Just tonight,” she said. “You go. Come back tomorrow night after work.”
“I’ll see if I can get the schedule shortened. I can be here early.”
“Good. Come early.”
“You sure?”
“I want to be here with her.”
So he agreed. He kissed Jamie’s cheek, smoothed her hair away from her forehead. He hailed a cab to the train station. He returned to a house that was different than he had left it. Nothing was missing, all the decor was intact, and yet he felt the strangeness of the space, as if it had grown unfamiliar.
In the morning he called Emily, who reported that all signs were looking good: Jamie had eaten Jell-O. Emily encouraged him to go ahead and see the patients who were scheduled, not to cancel his appointments. She could stay on with Jamie at the hospital.
He hesitated, but then accepted. Getting back to the office felt like a relief. It took his mind off everything to work, to ask patients questions about their problems. Rita stepped into his office to tell him that two more people had called to ask about the sulmenamine infusion.
“You all right?” she asked. “You’re in a daze.”
The office was in full swing already. For a moment, he thought he might tell Rita that Jamie was in the hospital, that he might need to cancel the late appointments, but he decided not to.
“He’s fine,” Gabi answered from the hallway. “He got his head in the clouds. Ready to be important.”
They had expectations. The patients and even his staff. They had expe
ctations for him, and now they had expectations for his new therapy. He didn’t want to admit it to anyone, but his resolve to explore sulmenamine was wavering. He’d begun to realize the therapy was going to be harder to promote than he’d imagined. He was faced with having to devise a PR strategy for it. He’d have to market it and send out fliers and think up catchy phrases and win over the press, all of which was less interesting to him than the investigative work in the clinic. And he didn’t want to attend any more conferences until it was clear that he’d had enough undisputed successes to make other doctors sit up and take note.
But how many did he need? As it was, he had eleven patients who’d received shots. He’d turned down one person who wanted to try it, the friend of a friend of Maxi Bailey, because the man seemed odd. It was a snap judgment, but Simon found the man’s manner too demanding, a bit too tetchy, and he didn’t want his experiment dragged down by the type of person his mother would have called “a bad apple.” He offered the man a heavily dosed prescription of Fentanyl instead, which turned out to be a fine solution for both of them.
When the first officer entered, Simon was in the hallway outside the exam suites, hunched over a patient chart. It was nine forty-five on Tuesday morning, and he’d already prescribed treatment for a thirty-two-year-old high-school teacher with uncontrolled acid reflux. He’d drained a tart-smelling abscess from the infected toe of a fifty-one-year-old plumber. The sore spot in the side of the sixty-five-year-old architect was most likely a hernia, he decided after careful palpation, and he was standing in the hallway, writing up a referral to a surgeon. That morning, before the routine appointments, he’d also seen a new patient, a twenty-eight-year-old woman named May Anderson, who’d come in with complaints about low back pain. There was nothing remarkable about her or the discomfort she described; she’d fallen on the ice the previous winter and jarred her tailbone. Her case sounded similar in many ways to several of the new pain patients he’d taken on in the last three weeks. She’d been forced to take days off work and she’d lost pay. She’d seen “like, ten other doctors,” she said, and nobody could help her.
He asked where she hurt, and he asked what kinds of therapies she’d tried out. She said she’d been to the hospital, and the X-rays were normal and that she could have them sent.
“I’m testing a remarkable new treatment,” he informed her. “It’s an injection, a double dose of a drug called sulmenamine. It’s safe, no side effects other than maybe dry mouth. For a lot of the patients I’ve seen, it completely blocks out pain.”
He was tired, and he was aware that he was not presenting the treatment with his typical enthusiasm.
“I want something proven,” she said quickly, leveling her gaze on his face. “I don’t want to test anything.”
“I’m very excited about this treatment,” he reinforced, hoping the presentation didn’t sound too rote. “It’s been the answer for a lot of people.”
“I’m no guinea pig,” she insisted.
He, who usually felt such compassion for people who complained of pain that kept them awake, or from work, was vaguely aware of not liking her. Her hair was almost black, dyed over with an eggplantish shade of purple, and she’d pulled it back into a short, stubby ponytail. The look was severe and added to the repugnance of her cockiness. She kept her hand on her back, and she occasionally massaged the muscle with her thumb as if to ease it. Each time, she emitted a small grunt. Typically, he would have been inspired to puzzle through her symptoms and a wide variety of treatment options.
“What is it you’d prefer?” he asked with resignation.
“Like, how about Dilo—” She gave a stiff, slightly embarrassed laugh. “I’m not even sure what it’s called.”
“Have you been on Dilaudid before?” he asked.
“A while ago,” she said with one of the little grunts. “It was the only thing that made a dent.”
Later, he would think he should have asked more questions, as if knowing who’d prescribed it or how much would have made a difference in what came next. He would wonder if he’d been too tired to be vigilant because of lack of sleep, or if he’d been distracted because of everything that was going on with Jamie. He would wonder if he’d known—somehow—that the trap had been set for him and that all there was for him—for his own well-being—was to wander into it. What he decided, as he regarded her and the severe cap of bruise-colored hair, was whatever she wanted he was ready to give her. He didn’t want to have to look at her any longer, let alone negotiate with her.
“I’ll give you a prescription for Dilaudid,” he told her. “We’ll start with a small dosage, keep in touch and determine together how well it’s working.”
“Can I ask—would you—I was just wondering, can you give me more than a month’s worth?” She cocked her head, pleading. “It’s like a huge bother to have to keep going to the drugstore. And they’re not that nice to me there, if you know what I mean.”
“If you want, I’ll send you to a pharmacy in Glenburnie. I know the guy, and it’s a little bit off the beaten path. You won’t feel you’re under scrutiny.”
She seemed satisfied. The appointment ended, and he went to the next patient. He was not particularly focused. The article by the Sun reporter Casey Rehem, which had appeared the day before, had not been flattering. After his experience in Salt Lake, he was hardly surprised. The world looked skeptically at people whose practices were not part of the mainstream and who dared to make claims that were too bold, too self-assured. If he’d been part of a university or a member of a pain cohort, his observations might have been taken more seriously from the start. And his conclusions might have quickly drawn attention and then might have been followed up by other researchers. As it was, he was labeled “an outlier,” in the words of one neurologist who was quoted in the article. The neurologist was named Marvin Volk, and Simon had never heard of him either, but the writer had quoted Volk’s caution to the public not to believe unsubstantiated claims about silver bullets for long-standing pain. “Unfortunately, as of today,” Volk said, “we’re still far from a cure.”
With exacting detail, Casey Rehem had depicted how Simon had found the stash of sulmenamine in his father’s bedroom. Casey had made finding vials in the drawer sound like stumbling upon loot, but Simon still felt the discovery had been a moment of intrepid shrewdness and investigative necessity, which he figured was probably impossible to convey in print. Dredging up past conflicts, Simon came off as eccentric and possibly unaccountable. Casey had interviewed partners at Guilford Medical Associates, who’d recalled how they’d asked Simon to leave after he’d disagreed with them about prescribing narcotics. “We had differences about how much to give patients, how often and for how long. We don’t like using opioids as much as other therapies, and we determined it would be best to part ways,” as good old Brad Neuworth apparently had told the reporter. There was even a line in the article about how Simon had received a cautionary reprimand from the State Medical Board for overstating the effectiveness of the Boardwalk Diet.
The strangest and most hurtful part of the article was the quote from Julie McKinley, described as a nurse who had recently “left” his practice. “There might be a method in the madness,” she said, “but I couldn’t defend most of the unorthodox practices I saw while I was working there. Patients deserve more than someone who looks like their advocate but whose ego drives him to unusual procedures.”
Simon had read the article sitting at the kitchen table, occasionally looking out the bay window at the garden, the almost-finished gazebo at the edge of the lawn. Emily had often said, “No such thing as bad press.” He’d heard her on the phone with clients, “It’s all about how we handle it.” She would know, and he was determined to move ahead and not let the article bother him. He knew what he was seeing in his patients. Jack Whitby was cured of the pains that had cramped him for over a year. The phantom pains had subsided in Jim Weaver. And the article, even in its uncharitable skepticism, only succeed
ed in getting the word out to greater numbers of people. He expected he’d be receiving even more calls from potential patients. He went down to the office and shot off e-mails. “How is your back???” he typed to one of them.
When the first officer entered, Rita was sitting at the reception desk with her hands-free headphones, assembling the paperwork to be filed for patients in the bear-embossed folders. In the back of the office, Gabi stocked a cabinet with paper towels, sterile plastic sample cups and tiny swollen packets of moist towelettes. Joyce was taking vitals from the patient in exam suite A, pumping the sphygmomanometer with her large hands. In the afternoon, he was due to perform two sulmenamine infusion therapies. One was for Maxi Bailey, whose pain had gone away for almost two weeks, but then had returned. She wanted another round. She believed in it—those days she’d been able to get out of the house had given her a glimpse of what remission would feel like—and she wanted him to give her another dose. The second was for a new patient, Ethel Vorhip, who happened to be the mother-in-law of the provost at the university. The route of information had been, of all people, Lorraine, his housekeeper, who was friends with the woman who cleaned for the provost. This, he believed, was a coup. The mother-in-law of the provost was the sort of connection that could get the treatment noticed by the right kind of people.
Writing up the hernia referral, he grew aware that something was happening in the front, out by the waiting room. The first officer was standing by the reception desk in a dark padded vest. Before he turned the corner, Simon heard Rita gasp.
“Police,” the man said in an authoritative voice that was surprisingly calm. “Nobody move.”