The Devil You Know

by Freida McFadden

  I walk into Primary Care C, where Dr. Kirschstein is standing there in his white coat with a patient chart in hand. He looks down at the floor where I’m still somehow depositing glitter everywhere I walk.

  “Sorry, Dr. Kirschstein,” I mumble. “My daughter… there was glitter in her room and…”

  He frowns at me. I’m scared that I really am somehow going to get court marshaled for this. “I’m bringing you my wife’s book on child management,” he says.

  “Oh,” I say. “Um, thanks.”

  “This time I won’t forget,” he says. “I think you could benefit from it, Doctor.”

  I stand by my original assertion—glitter is worse than herpes.

  (But it’s better than play-doh.)

  _____

  Today I have been blessed with another visit from Herman Katz.

  I’ve had two this week. Barbara claimed he called this morning, begging to be squeezed in, and I had a gap between patients, so she put him in. Which she’s not supposed to do without asking me, but what can I do? At least she didn’t ask me to clean glitter off the floor.

  “Dr. McGill, my toe is killing me,” Mr. Katz tells me as he sits in front of me with his shoes off, his bare feet dangling in front of me. Just like there should be a rule about not smoking prior to a doctor’s appointment, there should be a rule about washing your feet prior to a doctor’s appointment to discuss your feet. I’m breathing through my mouth.

  “Okay,” I say. “Which toe?”

  “My big toe.”

  “Which foot?”

  “I don’t know.”

  I want to slam my computer mouse down on the ground and stomp on it. “You don’t know?”

  “Well,” Mr. Katz says thoughtfully, “it doesn’t hurt right now. It just hurts sometimes.”

  Great.

  “Also,” he adds, “I’m worried because my grandmother had… um, a goiter.”

  I frown. “Do you mean gout?”

  He shakes his head. “No, I think goiter. What’s the difference?”

  “Gout is what you get in your toe joint,” I explain. “A goiter is in your neck.”

  He thinks about it for a minute. “I’m pretty sure she had a goiter.”

  So what does that have to do with your toe hurting??? I want to scream the words at him, but I keep my mouth clamped shut. I’m sure in Mr. Katz’s brain, it all makes sense. And the truth is, I don’t really want to know.

  I examine Mr. Katz’s feet (wearing two layers of gloves). I don’t see any signs of joint swelling associated with a gout attack. But he has a horrible case of fungus on his toes, so I write him a prescription for an antifungal cream, and I also order a blood uric acid level, which is a test of the crystals that form gout. Even though I’m ninety-nine percent sure he doesn’t have gout.

  “Dr. McGill,” he says after I’m done examining him. “Do you think that there’s any chance that this could be…” He lowers his voice several notches. “Cancer?”

  “No,” I say firmly. “It’s not cancer. Definitely not.”

  Hell, it’s not even gout. It’s nothing.

  “Thank you so much, Dr. McGill,” Mr. Katz tells me. He shakes my hand with warm, slightly stiff fingers. “It always makes me feel a lot better when I get to see you.”

  I know it does. That’s why even if Barbara had checked with me, I would have allowed her to squeeze him in.

  “My pleasure,” I say.

  After Mr. Katz leaves, I notice that we’re out of the white paper that I roll onto the examining tables. The roll is completely empty. I head down the hallway, to the waiting room. Barbara is sitting at her desk, her blond mullet teased to the extreme, texting someone on her phone while two people wait. I don’t think she’s even checked them off yet.

  “Barbara?” I say.

  After about fifteen seconds, she looks up. “Yes?”

  “I’m out of the paper roll for the examining table,” I tell her.

  Barbara shrugs like I’ve told her something very uninteresting. “Oh.”

  “Could you help me to change it?” I ask.

  She shakes her head. “That’s not my job.”

  Of course. If it doesn’t involve making a check on a sheet of paper, it’s not her job. “Well, do you know where I can find more paper rolls?”

  She shrugs again. “Supply closet, maybe?”

  There’s a supply closet all the way at the end of the hallway that I try desperately not to enter. First of all, it smells like mold. Probably because there’s mold in there. Second of all, it’s so packed with supplies that it’s dangerous to go in there. You never know when an ACE wrap will fall down on your head and knock you unconscious.

  Back when I started working here, I grabbed a bunch of supplies from another primary care unit’s closet that isn’t as scary as ours, and stashed them away, so I’ve been mostly using that and replenishing as needed. But I don’t think it would look right to go to another unit and come out with a huge roll of paper. I’ve got no choice but to venture into our own supply closet.

  The moldy smell in the closet hits me the second I enter the room—I’ll be breathing through my mouth again. I wonder what’s growing in this place. I imagine spores entering my lungs and replicating in there. Ugh.

  I start sorting through dusty boxes of bandages and syringes. Everything is covered in layer of dust, probably because everyone else is as afraid to use this supply closet as I am. I push aside a plaster mold of someone’s foot, crouching on the ground to see if there are any paper rolls. But there’s no sign of them.

  I wonder who was changing the rolls up to this point. The paper roll fairy? And why did they suddenly stop?

  Finally, I spy a huge cardboard box up on a top shelf that looks promising. The only problem is that I can only just barely reach it on my tippy toes. If I were to nudge it off the shelf, it would almost certainly fall on my head and possibly kill me. Maybe I could stand on a chair. All the chairs in the examining room are rolling chairs, but if I go to the waiting room—

  “What are you doing in there?”

  I whirl around and see none other than Ryan Reilly standing behind me. He’s wearing his green scrubs again, he’s got his arms folded across his chest, and he looks mildly amused.

  “I’m trying to find paper rolls for the examining table,” I explain.

  Ryan raises his eyebrows at me. “And how is that your job?”

  “Look,” I say, “I think they’re in that box up there. Could you help me or not?”

  He grins. “Your wish is my command.”

  He reaches up and grabs the box from the top shelf. It’s clearly quite heavy based on the contents, but he doesn’t even grunt when he lifts it. But I do see the muscles in his biceps bulging as he lowers the box to the floor.

  I’m embarrassed how thrilled I am to find a stash of paper rolls in there. I pick out three of them, thinking I’ll stash two of them away for when I’ll almost certainly have to do this again in the future. Ryan just looks at me and shakes his head.

  “That’s how things work at the VA,” I say defensively.

  The phone in Ryan’s pocket buzzes. He picks it up with a gruff, “Yeah?” He listens for a minute, then says, “I’m not coming down to the OR until the patient is completely prepped and ready to go…….. Yeah, too bad…… Well, call me back when you’re ready for me to cut.”

  He shoves the phone back into his pocket and winks at me. “And that’s how it’s done, Jane. You don’t let them boss you around.”

  That might work for a hotshot vascular surgeon. Not for a dime a dozen internist.

  “What are you doing here, anyway?” I ask him as I walk back to the examining room to switch out the rolls. I have some unknown number of patients waiting to be seen, so I don’t have time for chitchat.

  “Just wanted to give you a heads up on one of my patients you’re seeing today,” he says. “His name is Donald Maloney. I’m doing a fem-pop bypass on him next week.”

  I make
a face at him. “You really had to come all the way here to tell me about that?”

  He grins. “No, not really.”

  I start fiddling with the metal bar holding the empty paper roll in place. “Well, thanks for your help and all.”

  Ryan watches me struggling to get that damn empty roll off. The metal seems rotted into place. I know it must have been changed relatively recently, but this seems impossible. After a minute of fumbling, Ryan shoves me out of the way.

  “Let me do it,” he says. “This is painful to watch.”

  I’d been looking forward to watching Ryan fumble with the roll the way I did, but amazingly, he slides it right out like he’s been doing it his whole life. Like all surgeons, he’s good with his hands. His are so steady—I’ve always admired that about him.

  “How is your dad doing?” I blurt out.

  Ryan looks up sharply. An unreadable expression comes over his face. “He died. A few years back.”

  “Oh,” I murmur. “I’m so sorry.”

  “I’m not.” Ryan snaps the new roll of paper into place. “He’d been declining for so long… he wasn’t even… I mean, it was time. More than time.”

  His blue eyes avoid mine. When I first met Ryan way back when I was an intern in a medicine residency, I happened to run into him at a nursing home where his father was living. Ryan tried to make up some story about the whole thing, but the truth eventually came out. His father was sick. Very sick. With a disease called Huntington’s Chorea.

  Huntington’s Chorea is an affliction that usually hits people in their late thirties and early forties. It causes jerky, random, uncontrolled movements in the arms and legs known as “chorea.” It also causes difficulty with balance and eye movements. Eventually, patients have trouble speaking and swallowing. With time, their cognitive abilities are affected as well, and they decline into dementia.

  The other important thing about Huntington’s Chorea is that it’s not just random. It’s caused by a dominant gene. One that can be passed down from parent to child with fifty percent frequency. A coin toss.

  Ryan has two older siblings. He has a sister who was tested for the gene and found to be negative. He has a brother who was tested and found to be positive, and it ruined his life. Ryan decided he didn’t want to know.

  Not knowing allowed him to move on with his career and not become an alcoholic living in his car like his brother. But he decided that it would be irresponsible to ever marry and have children, knowing what could happen to him in the near future, and what he might pass on to a son or daughter. At least, not until he knew that he was in the clear.

  Early in our relationship, I accepted that he didn’t want to get tested. But the longer we were together, the more it infuriated me what he was doing to himself. I was sure that he would have wanted to get married and have children if not for his fear of getting sick. If he was going to live his life like he had Huntington’s, why not just get tested? Not only was it affecting his life, it was starting to affect mine as well. I wanted him to bite the bullet and get the test.

  But no. He was adamant. He didn’t want to know.

  So I left.

  “How is your brother doing?” I ask him. His brother is several years older than he is, likely in his fifties by now or close.

  Ryan sighs. He hasn’t told many people about his family illness. I was the only person in residency who knew, which also meant I was the only person he could talk to about it. Most of the time, he liked to pretend it didn’t exist, but there were other times when he needed to talk. And I’d listen.

  “Nick’s awful,” he says quietly. “I had to get him twenty-four hour care just to keep him out of a nursing home. He can’t… he can’t walk anymore. I mean, he can, but he just falls, so we can’t let him.”

  “Jesus,” I murmur.

  “He’s been coughing on food and they’re talking about putting in a feeding tube.” He shakes his head. “But… I don’t think… I wouldn’t. I think he should just…”

  He blinks a few times, staring into the distance. He’s made it clear to me several times that if he had been in his father’s shoes, he never would have allowed things to go on as long as they did. He would never want to live that way.

  “But you’re okay,” I say, looking him over. He’s just as strong and healthy-looking as he ever was, even eight years older than the last time I saw him. “Right…?”

  He grins crookedly. “Yeah. Looks that way.”

  I let out a breath of relief. I’d been terrified he’d say he was having symptoms, despite how good he looks. “So you’re probably in the clear?”

  “Maybe,” he says with a shrug.

  “Was your brother having symptoms at your age?”

  Ryan nods.

  “So…” I allow myself to smile. “That’s great! I told you that you should have gotten tested!”

  He laughs. “So now I have to admit you were actually right about something?”

  Something else occurs to me, something I’m not sure how I feel about. “You can get married now,” I point out. “I mean, if you want.”

  “Yeah,” he agrees. “I can.”

  I clear my throat, busying myself by pulling some fresh tissue paper onto the examining table. Thanks, Ryan. “Any possible candidates?”

  He’s quiet for a minute. When I look up, he’s staring at me with those penetrating blue eyes. Silly as it sounds, my knees get wobbly. I haven’t thought about Ryan Reilly in such a long time, except for the once a year when he emailed me on my birthday. I’d forgotten how he made me feel.

  “Maybe,” he says. “I’m not sure yet.”

  I want to remind him that I’m married. I’ve got a great husband who knows everything about computers, loves cooking shows as much as I do, and gave me a beautiful daughter (even if we can’t seem to make any more babies). But I don’t say any of that. I just stare right back at him until his phone buzzes a minute later and he has to leave.

  _____

  I am utterly exhausted when I get home. My clinic ran late, thanks partially to Barbara’s overbooking habit. For the first half of the drive home, Leah treats me to verse after verse of “Row, row, row your Mommy,” until it suddenly occurs to her that she’s absolutely and painfully starving.

  “I’m huuuunnnnngry!” she wails like a child who has not eaten in several days, instead of a kid who was munching on graham crackers a mere ten minutes earlier when I picked her up.

  “Leah, what do you want me to do?” There I go again, attempting to reason with a three year old. “I don’t have any food right now.”

  “I’m huuuuuuunnnnnnnnnngry!” she sobs desperately.

  I try to ignore her best I can, but by the time I pull into the garage, I’m ready to lose it. I’ve got some chicken nuggets in the freezer that can be cooked in sixty seconds in the microwave. I’m going to make a beeline there as soon as we get out of the car.

  Leah is still wailing as I unbuckle her from her car seat. She now weighs over forty pounds, but I have to break my back every day wrestling her into this stupid car seat because that’s the law. I don’t get it—when I was a kid, not only did I not need a car seat, but I used to sit shotgun in the front. Now it just seems like height and weight limits for car seats keep increasing every year. I think it’s only a matter of time before I’m going to be forced to sit in a car seat, or at least a booster.

  When I get to the kitchen with a sobbing Leah trailing not too far behind, I feel my stomach turn. The kitchen looks like a hurricane hit. Ben has obviously been working from home today and the packaging from every bit of food he made himself is on the counter, as well as all his dishes. I grab the box from the TV dinner he made for himself and pop open the trash, which is too overflowing to accept one more morsel.

  I’m going to kill Ben.

  “I’m huuuuuuuuuuuuuuuuuuunnnnnnnnnnnnnnnnnngry!” shrieks Leah, clearly about to faint from hypoglycemic shock.

  I pull open the freezer and remove the bag of frozen chicken
nuggets, which is still unopened. I take out a handful of nuggets and put them on one of Leah’s plastic plates—the ones that have a smiley face on them, the only ones she’ll eat off of. Her eyes widen in horror.

  “Mommy!” she whimpers. “Those aren’t dinosaurs!”

  Sadly, I know exactly what she means. I asked Ben to pick up some chicken nuggets a few days ago, and I must have neglected to tell him that they had to be dinosaur-shaped. Or maybe I told him and he forgot. That’s more likely, actually.

  “Leah,” I say with all the patience I can muster, “they taste exactly the same.”

  “No!” Leah says firmly. “They’re circles. I don’t like circles. I only like dinosaurs.”

  “Leah!” I snap. “Either you have the circle nuggets or nothing at all!”

  My daughter’s little chin trembles. She’s so utterly adorable when she’s sad over something—I just want to reach out and scoop her up in my arms. This is definitely evolution at work, to make children so adorable when they’re at their most difficult.

  I cuddle Leah for a few minutes and we eventually compromise on a ham sandwich. I make it for her and get her set up watching Dora the Explorer in the living room. I’m sure I’m a terrible mom for allowing her to watch the amount of TV she does, but at this point, it’s the only thing keeping me sane.

  I walk upstairs to the bedroom I share with Ben. I find him sitting on our bed, his laptop on his legs like always. I wonder if that’s why we’re having so much trouble conceiving—maybe the laptop is killing all his sperm. He’s wearing his Yankees shirt, which is actually something I bought him years ago as a joke. Ben is from Boston originally and therefore is a diehard Red Sox fan, which means he hates the Yankees with a passion. So I bought him the shirt to tease him, but then Ben started wearing that shirt all the time. He told me that it reminded him of me. “You’re my little Yankee,” he would always say with a grin. He’s worn it so much that the Yankees logo is peeling off and there’s a hole in the seam of the sleeve. These days, he wears it out of laziness and comfort more than anything.