by Nancy Jensen
Nervously, Alma waited for Milton to smile and give her more details, but he did neither. How tired he looked.
“Son?” she said at last. “The baby—she’s all right? Isn’t she?”
“Oh, fine,” Milton said, and Alma breathed again.
“What are you calling her, dear?”
Milton picked up Alma’s coat and purse and handed them to her. “Sarah, I think. That’s the one Penny picked.”
Alma flushed, embarrassed by her forgetfulness. “Oh, Milton, I’m sorry. How is Penny? Let’s go to her.”
“She’s asleep,” he said. He reached into his pocket and pulled out his keys. “I‘ll get my coat and we can go. You can follow me to the house.”
“But, Milton…” So many words rose up, demanding to be said, that Alma couldn’t get hold of any of them. He wanted to leave now? He wasn’t going to stay the night with Penny? What about the baby?
Milton returned his keys to his pocket and sighed. “I guess you want to see her. Well, come on, then.”
He led Alma down the hall, through several turnings, and down other halls, but finally she saw the windowed wall of the nursery and pushed ahead of her son. “Where is she? Oh, where is she?” Alma scanned the rows of little cribs, each with its tiny swaddled bundle, and then at last—Baby Girl Crisp—a little redder than the others, being the newest, with just a few wisps of silky hair. Alma pressed her hands to the glass and leaned in, steaming the window with her whispered declarations of love.
“Are you a grandmother?”
Startled, Alma looked up to see one of the maternity nurses leaning out the door.
“Is this your mother, Dr. Crisp?” asked the nurse. “Well, we can bend the rules for her.” She motioned for Alma to follow.
A moment later, Alma was covered in a smock and being led by the nurse through another door into the nursery.
“She’s a little small,” the nurse said, bending into the crib, “but not bad for a preemie. She’ll be able to go home when her mother does.”
And then the baby was in Alma’s arms. “Sarah,” she said, more tenderly than she had ever said anything. “Sweet, sweet baby.” She caressed her granddaughter’s velvety little head with her cheek, wet from tears she couldn’t stop—tears she never wanted to stop. From somewhere inside her, a tune rose, and even as she began to hum it, thinking, Sarah, Sarah, she tried to recall what it was. A lullaby? No—an old song from the radio. “Blue Moon.” Something Daddy used to sing. As she hummed it through, the story of the song nudged up to her through the melody—and suddenly she knew that, until this moment, she had been that person, longing beneath that lonely moon, waiting for the love of her heart.
Alma sang softly on. She no longer noticed the lights, the low talk of the nurses, or the cries of another baby just waking. There was nothing in the world except this child in her arms. She gazed into the tiny face, dancing her darling in dips and sways, the two of them, together, under the blue-black sky, bathed in the brilliance of the newly golden moon.
Safely wound in her blankets, Sarah stirred like a leaf in a breeze, and Alma kissed her once, twice, three times.
So this is what a soul feels like, Alma thought—weightless but solid, a mystery that could warm beyond its warmth. Here was love that expanded. Love that multiplied, past measure.
March
It had surprised Alma—surprised her, but also made her proud—that Milton wanted to go right back into the office the day after Sarah’s birth. “I have patients scheduled,” he said. “If I cancel them, I’ll have to double-book for the rest of the week.”
“Of course, dear.” Alma poured him another cup of coffee. “I understand. Your father never liked to let his patients down, either. I’ll go to the hospital to help Penny.”
“I want you to come to the office with me,” Milton said. “Judy can’t check everyone in and do all the triage, too. You can go pick them up at the hospital after work, if it pleases you.”
Much as Alma had longed to return to the nursery—to hold little Sarah, to rock her and tell her of all the things they would one day do together—she was touched by her son’s need of her. Not that need was a word he had ever been able to say to anyone. Naturally, it was too short notice for him to hire a temporary replacement that first day, but he made no mention of it for the next day or even the next week. It was his way of showing Alma he trusted her. Like Gordon, Milton had always been strong, in control, incapable of showing vulnerability. It would have been unfeeling of her to press for explanations at that moment, when everything about his life was changing.
Though still it tore at her when she had to leave baby Sarah behind each morning, now, nearly five weeks after she’d arrived in Cincinnati, Alma had to admit she enjoyed replacing Penny as Milton’s office manager. In all his years of practice, Gordon had never asked her to tend his office for him, not even for the short while between one girl quitting and another hiring on—sometimes as many as four or five in one year.
That first day, as Milton showed her around the front office, she’d found herself growing excited about her new responsibilities.
“The patients’ medical files are organized by last name in the green filing cabinets, and,” Milton said, tapping a few keys on the computer, “in the files here, on the hard drive.” He pointed to a set of low black cabinets with double-width drawers beneath the window. “The insurance records are in there, filed in numerical order by the patients’ Social Security numbers. You won’t need to bother with those. Penny will catch up on all that when she’s back full-time.”
He plucked three black pens from a cup on the desk and fixed them in his jacket pocket. “All you have to do is check the sign-in list when someone comes in, pull the patient files, and leave them on this ledge for Judy. She’ll do the rest. If I’ve asked the patient to schedule another appointment, Judy will tell you that. There’s no reason for you even to open the folders.”
“What about billing?” Alma asked.
Milton shook his head. “When Judy hands the folders back to you, put them here.” He lifted a portable file case from the top of the nearest green filing cabinet. “I’ll take them home to Penny. She’ll transcribe my notes, put everything on disk, and on Saturday, you can stay home with Sarah while Penny and I come in to transfer the files and do the billing.”
Alma had never been happier, but Gordon was furious with the arrangement, especially after Milton told his father over the phone that it wasn’t worth hiring someone else, since Penny might decide anytime she was ready to go back to work. “He wants to talk to you,” Milton said, handing Alma the phone. When Gordon had blown out the worst of his fury, she did her best to explain to him how to do the laundry and prepare simple meals for himself. Ten days later, he showed up at Milton’s, grumbling that he had run through all his clean clothes and swearing he would never eat another frozen lasagna. Once he settled in, though, it wasn’t any more difficult to tend to Gordon than it would have been at home, and Alma simply set about establishing a pattern for their blended household.
In the mornings, she got up first, lightly bouncing Sarah in her arms while the bottle of formula warmed on the stove. Then Alma would make the coffee, wake the others, and start breakfast. When she’d finished loading the dishwasher, she would go and get dressed for the office, check Sarah’s diaper, and sit with her for a few moments in the rocker before handing her off to Penny, who seemed to appreciate the orderliness of the schedule, taking the baby into her arms with mechanical efficiency.
When Sarah woke in the night, Alma—remembering how exhausted she had felt as a new mother—would slip carefully out of bed so as not to disturb Gordon, stop outside Milton and Penny’s closed bedroom door, and say quietly, “I’ll see to her. You two need your rest.”
After work, she’d do the grocery shopping, then come home to cook dinner, cleaning up the kitchen afterwards while the others relaxed in front of the television. More often than not, Sarah lay in her carrier, cooing and blowing
bubbles, perched safely in the center of the table while Alma put away the dishes.
How strong she felt—invigorated. Back in McAllister, she had always been exhausted by seven or eight o’clock and struggled to stay awake until ten so she’d sleep through the night. Now sometimes she didn’t lie down until past midnight, and even if she’d been up with Sarah two or three times, she would wake again at five thirty, perfectly refreshed.
“You look younger every time I see you, sweetie.”
Alma looked up to see Mr. Radford, who came in once a week to have his hemoglobin and his blood pressure checked. He was eighty-seven and was dropped off by the downtown shuttle from the Senior Center, where he spent the days while his grandson was at work.
“I’ll tell Judy you’re here, Mr. Radford,” Alma said, starting up from her chair.
“No, no,” he said, laying a bundle of papers on the counter, frayed from having been folded small enough to fit his back pocket. Alma now remembered it wasn’t Mr. Radford’s usual day.
“I need you to look over these papers for me,” Mr. Radford said. “Gladys says she thinks they’re not right.” Gladys, Alma knew, was Gladys Bishop, a friend of Mr. Radford’s from the center and another of Milton’s weekly patients. Mrs. Bishop had to watch her blood sugar.
Mr. Radford unfolded the papers and smoothed out the creases with his fist. “It’s the insurance has made the mistake, but they won’t talk to me about it—just treat me like some old fool that doesn’t know what’s what.” When he grinned, Alma caught a flash of the gold crown he’d shown her once to prove that his teeth might not be what they’d been when he was twenty, but they were all still his own.
Mr. Radford reached through the window to hand the papers to Alma. “You tell them you’re calling from the doctor’s office, and they’ll listen to you,” he said.
Alma adjusted her glasses and tried to make sense of the claims report. Separated into columns were codes that corresponded on the back to various procedures. In the next column was listed the doctor’s charge, followed by how much of the charge the insurance would pay, followed by the difference owed by the patient. The amount owing after insurance for each procedure seemed awfully high—anywhere from $30 to $150—and Alma started to speak. Seeming to read her thoughts, Mr. Radford said, “It’s not that last bit I’m worried about, where it says I owe the doctor. Dr. Crisp has been awful good to me—to Gladys, too. Well, to all of us down at the center. He’s always said he’ll take only what the insurance pays, never has asked a one of us for a penny. Can’t ask for better than that.”
“Yes,” Alma said. “Milton’s a good and kind boy.”
“It’s all those numbers at the start,” Mr. Radford said. “They make it kind of hard to understand, the way they just use the numbers and put all the words in that doctor’s language on the back page in that ink you can’t hardly see.” Alma turned over the page and saw the details corresponding to the codes written in type so small, in such ghostly gray ink, that even she had trouble reading it.
Mr. Radford went on: “Then Gladys had the idea that I bring in one of my other statements—seems like I get three or four a month—and I read off the numbers while she checked them against what it says on the back the charge is for.”
“It’s always handy to have a second pair of eyes,” said Alma. “What’s the trouble, do you think?”
“It’s the charges,” Mr. Radford said. “I don’t know what those insurance people are up to. Probably just not paying attention.” He shifted from one foot to the other and then back again. “You know I come in here every week so Judy can stick me to make sure my blood’s still red enough.”
“Yes.” Alma nodded. “The hemoglobin count.”
“And then she blows me up with that cuff of hers.”
Alma flipped the paper over again and quickly identified the codes for those two procedures. Each code was listed twice, followed by different dates corresponding to two consecutive weeks in January, before she had come to help. She opened the appointment book and noted that Mr. Radford had been scheduled those days, and had come in. With a pencil, Alma made a light check mark for each code she could identify, but two other codes, also each listed twice, with different dates, remained. She checked these dates in the appointment book and couldn’t find Mr. Radford’s name.
“You always come on Wednesday, Mr. Radford. Isn’t that right?”
“I do. So what I want to know is why they’ve charged me for a couple of Fridays.”
Alma checked the codes again. According to the claims statement, Milton had been paid for two cholesterol screenings and two regular office examinations. “Doesn’t Judy always do your blood tests?” Alma asked.
“She does.”
“Do you remember if you saw Dr. Crisp for anything else last month? I don’t have you in the book, but maybe he worked you in?”
Mr. Radford shook his head. “Last time I was in for anything but the blood was about a week after Thanksgiving,” he said. “My grandson had all the family down—did I tell you I have five great-grandchildren so far? There was a lot of commotion—you can understand—and I ate some things I shouldn’t and didn’t sleep so well, so it wasn’t any wonder I picked up a nasty chest cold from one of the kids. I saw the doctor for that, but nothing else since. My hemoglobin’s been so good, I haven’t had to go for a transfusion since last summer.”
Just to be sure, Alma studied all the codes and dates once more. “I expect they’ve confused your records with someone else’s, or maybe Penny accidentally billed you for another patient’s procedures,” she said. “Having a baby can make a woman’s mind awfully fuzzy.”
Mr. Radford laughed at that and told her a story about how his wife, after their first baby was born, kept putting stamps on letters without ever addressing them.
Alma looked at the statements again, wishing she knew more about how the insurance was filed so she could figure out what had happened. She hated to burden Milton and Penny with it. Last Saturday, when Penny woke up with a headache and told Milton she thought the billing could wait another week, he’d taken her back to the bedroom, where they had argued in loud whispers for nearly an hour. It would help ease so much anxiety for them if Alma could solve this problem.
“I thought about showing these to my grandson,” Mr. Radford said, “but I don’t like him thinking I can’t handle my own business. Peter has his own trucking company. He’s used to dealing with papers and red tape and such.”
“Oh, I don’t think we need to bother him just yet,” she said. “You leave this with me.” Alma refolded the pages and tucked them into her purse. “I’ll get to the bottom of it.”
Later that afternoon, after Judy had left and Milton was pulling on his overcoat, Alma said, “I have a few things to finish up, dear—four or five reminder calls to people scheduled for tomorrow. And then I have some errands to run.”
Milton stared at her.
“Don’t worry,” Alma teased. “Dinner’s all ready. There’s beef stew in the Crock-Pot, so all you have to do is heat up some rolls if you want them. They’re in the freezer. Penny can manage those.”
“It’s getting dark out,” Milton said. “I’ll wait for you.”
Alma blushed at his concern. She squeezed his hand. “Really, dear, it’s all right. I’m a big girl.” When her son hesitated, she added, “Yes, I know how to reset the alarm when I leave.” She bumped his shoulder playfully. “You go on. I know you’re tired.”
Milton stood in his place for another moment, his fingers clutching a button of his coat, but at last, without another word, he left, pulling the outside door hard behind him.
Alma took Mr. Radford’s statements from her purse and opened the appointment book to the first date when he was mistakenly charged for the cholesterol screening. It took a few minutes to pull the patient files for the people listed that day, but now they all lay before her. One by one, she opened the folders, looking for some evidence that someone else on the same day had c
ome in to have a cholesterol check. This was more difficult than she had expected, because, in spite of Milton’s notes having been transcribed to typed pages, the procedures were shortened to four-digit billing codes—in most cases, three, four, or five codes for each patient. Several of the records showed the code for cholesterol tests, but there was no surprise in that. Old people had to watch their cholesterol.
Alma took Mr. Radford’s folder from the bottom of the pile and opened it. The only way to do this, she decided, was to be methodical and look at least briefly at every sheet of paper. The first several sheets, which she laid aside one by one, were Penny’s typed notes. Then came a photocopy of Mr. Radford’s insurance card—he was one of the lucky ones from the Senior Center who didn’t have to rely on Medicare. He’d worked for the railroad for nearly fifty years, and they still paid for his coverage. Behind that was his original patient record, filled out during his first visit. Alma noticed the date, just a few weeks after Milton had opened the practice.
Next, gathered with a binder clip, were the forms Judy and Milton used for their notes during the patient’s visit. At the top of each, Mr. Radford’s name was scribbled in Judy’s handwriting. Most of the notes were Judy’s, but Alma did find Milton’s notes from the early-December visit Mr. Radford had mentioned. They were hard to read, but when Alma got the hang of it, nothing seemed amiss. She wasn’t going to find the answer this way, she decided, so she carefully tapped the pages back in place and fastened the clip.
Alma gathered the loose sheets she’d set aside and was just about to place them back in the folder when she caught a glimpse of writing in the lower left corner of a notes page. She pulled the stack out again to look—a pair of four-digit numbers written in fine black ink, followed by a plus sign and another single digit. She lifted the first page to see the second, and there was one number marked in the same space. On the next there were three, and on the one after that, two again, then one. Every page of notes had codes listed in the lower corners.