The Devil You Know

by Freida McFadden

  I’m not any great expert at the ophthalmic exam, but everything looks fine in his eyes. However, I notice that he has a whooshing sound or “bruit” over his left carotid artery. This is indicative of a blockage in the artery.

  “I’d like to order some tests,” I tell him. “Including an ultrasound of your carotid arteries. And I’d like to refer you to our Eye Clinic.”

  His eyes widen. “What do you think is wrong?”

  “I think it could have been a mini-stroke.” Patients seem to prefer the term “mini-stroke” for a TIA. It’s as good a term as any. “But I’m not sure yet. We need to check out your eyes before we jump to any conclusions.”

  Honestly, Mr. Katz looks so worried that I want to give him a hug. Part of me wonders if he would have come here in the first place if he knew that I wasn’t just going to tell him everything was fine like I usually do.

  _____

  Between you and me, I strongly consider dumping the giant plant in the garbage on my way out. Except I can’t because it’s too big to fit in any of the garbage bins.

  I lug it out to the elevator, my arms actually trembling with the effort of holding it. This thing is way heavier than Leah. And there’s no good way to hold it without the branches and leaves smacking me in the face.

  Just my luck, the first elevator that comes belongs to George the elevator guy. I consider making an about-face but I recognize in this one situation, it might actually be useful to have George pressing the buttons in the elevator for me.

  I start to climb inside but George holds up a hand. “Wait,” he says. “I don’t know if I can let you in with that thing.”

  I stare at him. “What?”

  “You might need to take the service elevator,” he says. “It looks hazardous.”

  He’s got to be kidding me.

  “Please?” I say. “I’ll be really careful.”

  George looks me up and down. Finally, he sighs. “Fine. But just this one time.”

  Does he think that I’m going to make it a habit of carrying around a gigantic plant? Christ, I sure hope not.

  The elevator seems to be traveling painfully slowly. I’m trying to keep the plant from slipping out of my fingers, debating if I should just put it on the ground for the duration. That’s when the elevator doors open and Dr. Ryan Reilly strides in wearing scrubs and a jacket. I’m not entirely sure he sees me though, since my face is concealed by leaves and branches.

  “Hey, George!” Ryan says.

  To my utter shock, a huge smile breaks out on George’s face for the first time in the entire year I’ve known him. Ryan holds out his hand and George gives him an enthusiastic high five. What. The. Hell?

  “Did you catch the Knicks game last night?” Ryan asks him.

  “You know I did!” George says. “Man, that game was too close for comfort.”

  “You kidding me? I knew the Knicks had it all along.”

  They chat about the Knicks game for another minute while I stand quietly, hoping Ryan doesn’t notice me. Except at one point, he glances over in my direction and winks. A month ago, that wink might have done something for me—but right now, all I can think about is how I’m going to get this stupid plant home.

  “So what’s with the man-eating plant?” Ryan asks me as he gives George a parting fist bump and we exit the elevator in the lobby.

  I shift my grip on GinormoPlant for the hundredth time. “A patient gave it to me.”

  He rolls his eyes. “Give me that.”

  I don’t protest when he takes the plant out of my hands. “I have a question for you.”

  “Shoot.”

  “What is your cut-off percentage of stenosis to do a carotid endarterectomy?”

  He looks at me thoughtfully. “Is your patient symptomatic?”

  “He had a brief episode of monocular blindness.”

  “And how stenotic is he?”

  “Don’t know yet.” I shrug. “I just ordered the carotid ultrasound.”

  He shakes his head at me. “You’re asking me for a consult and you didn’t even get the ultrasound yet? For shame, Jane. Call me when you actually get the study done. You don’t even know what you’re dealing with.”

  “Say he’s at seventy-five percent,” I say.

  “Seventy-five percent?” He nods. “Yeah, I’d do it. If he was otherwise a good candidate.”

  The last thing I want is to push Mr. Katz into a surgery. But at the same time, amaurosis fugax is a great indication for a carotid endarterectomy. Ryan knows it too—I’m sure he’ll do the surgery if the ultrasound shows what I think it will.

  He hands me back the plant when we get to my car. He smirks at the way I struggle to get a grip on it. “Good luck with that,” he says.

  I stick out my tongue at him, then feel embarrassed at having done something so childish. Leah must be rubbing off on me. Or else Ryan just brings out that side in me.

  “So things are better with Pip, huh?” he says.

  “Ben,” I murmur. “And… yes.”

  “Okay.” He nods. “If he’s a jerk to you, let me know and I’ll go beat him up or something.”

  I snort, imagining Ben and Ryan in a fight. They’re about the same size, but judging by Ryan’s biceps and the fact that my husband hasn’t been to a gym since before Leah was born, I think he might destroy Ben. Now, at least. In a year, that might not be the case.

  “See you later, Jane,” Ryan says. “Be good.”

  Be good? I’m always good. Well, except for that one time.

  Getting the plant into my car is no easy task. It’s much too tall to fit on the seat, so I end up putting it on the floor, where it still doesn’t really fit. The position of the pot is extremely precarious, but I’ll just have to drive carefully. I recognize that my car will be just one short stop away from having dirt all over the floor, but that’s okay—maybe it will block out the faint odor of urine that still clings to the back seat.

  After the plant is safely packed away in the car, I turn to watch Ryan walking to his car. I follow his steps, waiting for his body to jerk or for him to trip over his own feet. He does neither. He walks with certain, steady steps through the melting snow.

  I’d think his diagnosis was a mistake if I hadn’t seen it myself.

  I get in the car and drive as carefully as I can to Mila’s preschool. At every red light, I hold my breath and glance nervously at the plant. But by some miracle, I make it to the preschool with the plant still upright. It took about twice as long as usual, but I made it.

  I grab the plant from the floor of the front seat and yank it out of the car with me. I make my way carefully across the parking lot toward my daughter’s preschool. I’m eternally grateful when another parent is coming out as I’m coming in and can hold the door for me.

  “Mila!” I call out. “I bought a present for you…”

  Chapter 28

  “Mr. Turner,” I say. “Your cholesterol is even worse than last time.”

  Fred Turner frowns at me and scratches at his large belly. Mr. Turner has something called “central obesity,” which is a fancy way of saying that most of his fat is in the torso. It puts him at higher risk for heart disease, as does his high blood pressure and horrendous cholesterol. Mr. Turner is basically a walking coronary.

  “Did you do what we talked about last time?” I ask him. “You know, about eating less red meat and more vegetables? And using whole grain bread instead of white bread?”

  Mr. Turner nods slowly. “Yeah. Well, sort of.”

  “Sort of?”

  “See, I thought I was eating more whole grains,” he explains. “Like, I was buying a lot of whole grain bread instead of white bread because I know white bread is bad. But then I realized I was eating white bread in other forms by accident.”

  I raise my eyebrows at him. “By accident?”

  “Well, you didn’t explain it to me right.” He frowns at me accusingly. “You never told me that there were forms of white bread in donuts, pizza, la
sagna…”

  I stare at him. “Those foods are unhealthy for reasons other than their bread content.”

  He doesn’t seem to be getting it.

  I make Mr. Turner an appointment with the nutritionist, thinking maybe she’ll have better luck than I did. But also, I start him on a medication for his cholesterol. Because if you don’t understand why a donut is unhealthy, I think you might be a lost cause.

  Mr. Turner is my last patient of the day, so I’ve got time to catch up on labs and phone calls. The first thing that pops up is the report from Herman Katz’s carotid ultrasound. His right carotid is about fifty percent blocked and the left symptomatic side clocks in at ninety percent. I knew it!

  I look up Mr. Katz’s phone number under the demographics tab. He answers after only two rings with a breathless, “Hello?”

  “Hello, Mr. Katz,” I say. “This is Dr. McGill from the VA Hospital.”

  “Dr. McGill!” He sounds so obscenely thrilled to hear from me that you’d think he’d received a call from… well, I don’t know exactly who would impress Mr. Katz. Dwight D. Eisenhower? Ronald Reagan? Madonna? Someone important, anyway. “It’s so good to hear from you.”

  “Right.” What do I say to that? “Anyway, I just wanted to let you know that I got the results back from your carotid ultrasound—you know, that test they did on your neck?”

  “Oh yes.” Mr. Katz’s voice becomes tense. “Do I have cancer, Doctor?”

  “Cancer?” Christ, he’s single-minded. “No, you don’t. But you do have a blocked artery in your neck.”

  “Oh.” He seems completely befuddled, as if such a thing had never even occurred to him. Even though I explained it to him prior to the test. “What does that mean?”

  “Well,” I say, “it might have caused that symptom you had where you couldn’t see out of one eye. And if you don’t treat it, you might have a stroke.”

  “A stroke?” Mr. Katz sounds really panicked now. He might have dealt with cancer better—at least he was expecting that. “So what do I do to treat it?”

  “I’m going to put in a consult for you,” I tell him, “with a vascular surgeon named Dr. Reilly. He’s excellent. He’s going to take good care of you, Mr. Katz.”

  As I say it, I believe it. I really do. If I didn’t, why would I have referred him?

  _____

  When I come out of the examining room to get some lunch, I can hear Dr. Kirschstein in the next room over, apparently seeing a patient of his own. As loud as he is with us, he seems even louder when he’s within the examining rooms. Maybe it’s something about the acoustics of the hallway. In any case, I can hear his voice booming all through the hallway.

  “MR. MILTON, I THINK THIS RASH IN YOUR GROIN MIGHT BE CAUSED BY FUNGUS,” Dr. Kirschstein says to his patient, the unfortunate Mr. Milton.

  I can’t hear Mr. Milton’s response, but then Dr. Kirschstein continues: “ARE YOU WASHING YOUR TESTICLES AND PENIS OFTEN ENOUGH?”

  There’s a silence, during which time Mr. Milton is hopefully answering in the affirmative. Lisa comes out of an examining room and sees me standing there. She raises her eyebrows in the direction of Dr. Kirschstein’s room. “What’s the diagnosis?” she asks me.

  “IT MIGHT BE HARD FOR YOU TO WASH THOROUGHLY BECAUSE YOUR PENIS IS SO SMALL,” Dr. Kirschstein adds.

  Lisa clasps her hand over her mouth to keep from laughing. “God, I love Dr. Kirschstein,” she says.

  I roll my eyes. “Do you?”

  “Oh, absolutely,” she says. “Even the eyebangs are sort of sexy.”

  That gets a laugh out of me. “Would you put him on your list?”

  “I might,” she says thoughtfully, “if I were making an over sixty-five list.”

  “An over sixty-five list?”

  “Right.” She grins at me. “Celebrities over the age of sixty-five that I’m allowed to cheat with if the opportunity were to arise.”

  “I see.” I smile back at her. “And who would be on that list?”

  She comes up with an answer so quickly that I suspect she’s thought this over in the past. “Sting, obviously.”

  “Obviously.”

  “Harrison Ford.”

  “Okay. Reasonable.”

  “Robert DeNiro.”

  “Okay. And not totally unrealistic since he lives in TriBeCa.”

  “Samuel L. Jackson.”

  I raise an eyebrow. “Okay. I guess I can see it.”

  “And… Richard Gere.”

  I clasp my chest in mock horror. “No, not Richard Gere. He’s awful!”

  “No, he’s sexy.”

  “He’s such a scumbag.”

  “A sexy scumbag.”

  “YOU’LL WANT TO APPLY THE CREAM I’M PRESCRIBING THOROUGHLY TO YOUR PENIS,” Dr. Kirschstein booms. “YOU SHOULDN’T NEED MUCH SINCE YOUR PENIS IS SO SMALL.”

  Lisa giggles. “Speaking of sexy, what happened with your sexy surgeon?”

  I glance at my watch, wondering if my next patient has arrived yet, and knowing Barbara will never make me aware of it. “Huh?”

  Lisa tugs at one of her earrings. It’s a hoop so large that it nearly touches her shoulder. “You know who I mean. Dr. Sexy McSexerton.”

  “You mean Ryan?” I avoid her gaze. “I don’t know. He’s busy.”

  “It seemed like he was always sniffing around you for a while,” Lisa says. “Looking for you, pumping me for information…”

  I freeze. “Pumping you for information?”

  “Oh!” Lisa’s cherry red lips curl into a smile. “I didn’t tell you about that? I ran into him in the lobby when he first started. I was trying to make my usual brilliant conversation, but all he wanted to talk about was you. Jane, Jane, Jane…”

  I get this sinking feeling in my chest. “He did?”

  “And the way you’re always complaining about Ben…”

  “I don’t complain about Ben all the time!” I cry. Oh God, do I?

  “Well, not lately,” Lisa admits. “But you used to. How he wouldn’t change the toilet paper roll. Or how he’s always on the toilet when you want to take a shower. A lot of toilet-related complaints.”

  I laugh. “Well, I guess every couple has stupid problems like that.”

  “I like Ben,” Lisa says. “He isn’t a phony. And every time I see you guys together, it’s obvious he’s super crazy about you. Unlike my idiot husband, who’d probably trade me in for a twenty-year-old blonde in a heartbeat.”

  “Yeah, right.” Mike worships the ground Lisa walks on.

  “You’re lucky you didn’t end up with Dr. McCutie,” she says. “He’s probably an arrogant asshole.”

  There are reasons I’m lucky I didn’t end up with Ryan. But none of them are what Lisa thinks.

  Chapter 29

  I walk into the kitchen carrying two bags of groceries. I kick off my soggy shoes at the door, but the second I walk onto the tiled floor, my sock fills with water and I nearly slip and fall on my butt. I drop the bags on the floor and look down. The kitchen floor has two small puddles of water on it, one of which nearly broke my neck.

  “Hey, you’re home.” Ben wanders into the kitchen in his bare feet. He leans in to kiss me on the neck. “Did you get more of that peanut butter with honey at the grocery store?”

  “Ben.” I take a cleansing breath, trying to remember what our therapist said about not being confrontational or snarky. “Why are there two puddles of water on the floor?”

  His eyes drop and he notices the puddles. “Oh,” he says. “I spilled some water earlier.”

  “So… why didn’t you clean it up?”

  “Well…” He shrugs. “It’s water. So I figured, you know, it’s self-cleaning…”

  “Ben, it soaked my socks,” I say. “And I nearly slipped. You can’t just leave a puddle of water on the kitchen floor.” You idiot.

  A month ago, this might have started a huge fight. But today, it doesn’t. He just nods sheepishly. “I’m on it.” He goes to the counter and gr
abs some paper towels. “And I’m going to get you some new socks too from upstairs. Don’t even move. I’ll take care of everything.”

  I roll my eyes, but I’m smiling. “You don’t know where I keep my socks.”

  “I think I can find them,” he says. “Give me a little credit here. I do have a Master’s degree.”

  “Not in finding socks.”

  “No,” he says, “but that was my major in college. I was summa cum laude in socks. My minor was shoelaces.”

  I laugh and step back to allow Ben to clean up the water in the kitchen while I put away the groceries. He doesn’t have to bother with the socks though. Maybe I’ll put on my fuzzy slippers.

  “Hey,” he says, as he straightens up with a handful of wet paper towels. “Guess what? I wrote a new app that I think is going to be a huge success.”

  “Oh yeah?” I grin at him. “What is it?”

  “It’s called ‘Sorry Dear.’”

  “Hmm. I’m afraid to ask.”

  “It’s an app that helps you apologize to your significant other,” he says. “So if you’re apologizing to your wife or girlfriend, it sends them a poem. And it gives you the option of purchasing flowers from a local flower shop.”

  “And for the guy?”

  “Sports tickets.” Ben smiles. “Or a salty snack assortment.”

  “I have to tell you,” I say. “Your app sounds super sexist.”

  “Yes, it is super sexy.”

  I roll my eyes again, but actually, it does sounds like a good idea. Maybe he’ll make a million dollars and I can quit my job. Not that I’d ever really quit. What would I do with myself?

  My phone starts buzzing in my purse and I go to pick it up. I see that the extension comes from the hospital, but it’s not familiar to me. Ben raises his eyebrows at me and I shrug as I pick it up.