Meg followed down the hall and into a room on the right. Brianna, a thin, dark-haired, serious-looking woman who had aced every exam the university could throw at her during their med-school days, waited behind a glossy cherrywood desk so uncrowded that it seemed the practice had opened just that morning. Meg’s own desk was a cluttered collection of folders and samples and Post-it notes, and photos of Savannah, primarily, though she also had one of Brian and Savannah together, circa 1994.
Brianna stood, reaching out to Meg with a long-fingered hand. “Meg, you’re looking terrific.”
Meg reached with her right hand and shook Brianna’s. “Thanks. You too. You wouldn’t know it, but ten minutes ago, I was ready to cut this damn arm off.” To say the least.
“Pain?” Brianna asked as Meg sat down across from her.
“No, no pain—just the same thing I described to you over the phone: overall weakness. It comes and goes.”
They talked a little about each of their practices and their overfull lives. Brianna had nine-month-old twin boys, served on two research committees, and was leading a research trial of her own, plus her husband had just been laid off from an engineering firm and was trying to find new work. “Seeing patients here is the slow part of my day,” she said.
“I know how you feel. Thanks again for seeing me so soon; I really need to solve this mystery—I don’t have time to be laid up!”
Brianna put on frameless reading glasses. “Do you need these things yet? Every passing year I feel more and more like my mother.”
Meg felt the sting of loss. How long before the sting turned duller? How long before her first reaction was fond remembrance rather than sorrow? “No,” she said, “my vision’s still in good shape.”
“Lucky you. With all the reading we have to do…Let me have a look at the orthopedist’s report.”
Meg passed her the giant envelope. “He recommended a psychic,” she said, then waited, picking a hangnail, while Brianna read over Cameron Lowenstein’s write-up.
Brianna took the X-rays and slid them onto the light box to Meg’s right. “A psychic, huh? Funny, his report is so professional.”
“He’s eccentric. But I guess he knows his way around medicine.”
“Hmm.” Brianna studied the X-rays carefully, then switched off the light and went back to her chair. “I think a psychic might shortcut things for us, because I don’t see anything on the films.”
“No,” Meg agreed, “I didn’t either.”
“His official opinion is ‘inconclusive,’ but you said he brought up ALS.”
“Right. And so I looked over some of the literature,” Meg said, working to keep her voice steady, professional, though what she read had only confirmed what she remembered about the disease, “and until just before I came here, nothing more had happened. I was fairly convinced he was just casting in the dark.”
“ALS is a tough fish to hook—a lot of things look similar.”
Meg heard a pause in her voice. “So?” she said.
“So…his report notes no symptoms that rule out ALS…. There’s a whole lot of nothing here,” she mused. “No pain, in particular, but also you report no numbness, there’s no swelling, no spinal or joint compressions, no extreme fatigue or physical malaise. How long would you say you’ve been experiencing muscle weakness?”
“I really don’t know. I mean, I’ve felt tired a lot—not sleepy, you know, but like I just want to sit down and do nothing. I’m on my feet full-time, and I use my hands and arms all day long.”
Brianna nodded, empathetic.
Meg said, “If I had to make an outside guess, though? A few months. Maybe since late last fall, after my mom died and I added my father to my workload.”
“Understandable,” Brianna said. “So…why don’t you get into a gown, and then we’ll repeat the reflexes check, see if Lowenstein’s on the ball.” She sounded almost cheerful, a detective eager to track the clues. This, Meg thought, was one of the qualities that sent them down different medical paths: Brianna loved the hunt, the investigation, while she, Meg, preferred being a kind of creation assistant. An obstetrician was very often a bystander—a coach or a guide for one of the most basic of life’s processes. A big sister, passing on wisdom and supervising outcomes—like she’d done all her life.
In the exam room, Brianna put her through the same round of basic arm and leg reflex tests Lowenstein had, using a small, heavy hammer on her arms, knees, and ankles. Then she told her to clench her teeth while she pressed her fingers along Meg’s jaw and neck.
“Relax your fingers,” Brianna told her next, taking her right hand. She held Meg’s middle finger pinched between her own thumb and index finger, pressing the nail and sliding her thumb down it until her thumb clicked off the end of it. When it clicked, Meg’s other fingers flexed.
“Huh, that’s cool,” Meg said. Brianna didn’t reply but repeated the move twice more, then did it the same to Meg’s left hand. The click-flex response was less on the left.
Meg said, “I don’t remember that test.” It had been years since she’d done a reflexes exam on anyone—back in her residency, she thought.
“I’m checking for what’s called the Hoffman response. It’s basic neurological protocol, but you might not have learned it in general medicine. Honestly, I don’t remember when I learned what. Med school is all a caffeine haze in my memory, you know? Now, put your legs up here,” she directed, and Meg shifted so that she was lying on the exam table. Brianna grasped her right foot and flexed it back, holding it there. She repeated it, then did her left foot.
“Now I’m going to run a key up from your heel to the ball of the foot and across the metatarsal pad—the Babinski test.” She took the key from the pocket of her white lab coat. “Isn’t it fascinating how these things get named for whoever was bright enough to figure out the significance of the thing? Joseph Jules François Félix Babinski—his parents had trouble making choices, I guess. Now just relax your leg.” Meg lay as relaxed and still as she could, trying not to guess what Brianna was or wasn’t noticing as she stroked the sharp metal against each of the soles of her feet. Being the patient instead of the doctor was discomfiting to say the least.
“Okay, last one: just lie there and relax all your muscles.” She opened the front of Meg’s gown. “I’m going to stroke the key across your belly a few times.”
Afterward, Brianna had Meg sit up, then wrote extensive notes while Meg made herself wait without speaking. Finally, Brianna said, “Okay, why don’t you get dressed and meet me back in my office?”
“Why don’t you just say what you’re thinking right now? I know the drill about delivering bad news to the undressed patient.”
Brianna looked at her, lips compressed. “All right. This is not conclusive,” she said. “But okay. Yes. I see why Lowenstein was suspicious. He noted spasticity in his general exam…. And as I see it, the Hoffman response is troubling, in particular—your fingers shouldn’t flex at all. Taken by itself, I’d be concerned about a cervical lesion, but in conjunction with the clonic reflex of your left calf and low reflex response on your abdomen…”
She said some other things, but Meg was no longer focused on the words or even the tone of her old classmate’s voice. Her mind leapt ahead to what she’d read, to how no single one of those irregularities indicated ALS itself, but the combination of abdomen, foot, and hand signs and symptoms equaled what would be called a “clinically probable” diagnosis.
“…an EMG needle exam and an MRI, too,” Brianna was saying, “to rule out other possibilities. Why don’t you go straight to the lab for blood and urine tests, and I’ll have Heidi get you appointments for the others.”
“Right,” Meg said numbly.
“And even if we don’t unearth anything more optimistic, we’ll want to keep close tabs on your symptoms over the next several months before we can make a definitive diagnosis.”
Brianna’s voice was flat and factual, delivering the information like she m
ight in a lecture or panel discussion. Meg understood; it was only the rarest of physicians who could put an arm around a patient and tell him or her, in a warm, concerned voice, that a horrible, torturous slide toward certain death was on their horizon.
“How many have you had?” Meg said, interrupting Brianna’s suggestion that she get a more expert opinion from an ALS specialist she knew in Orlando.
“How many what? ALS patients?”
“Yeah. How many have you diagnosed since you started?”
“Three, in…what? Ten years? It’s almost always something else.”
Meg nodded. “And when the patient presents with pretty definitive symptoms like mine, what, in your opinion, are the odds that it’s not—” she looked Brianna in the eye, “…that it’s not ALS?”
“Meg, listen, there’s always hope—”
“And there’s acupuncture and psychics and herbal remedies, and the chance that I’ll find a beatific healer wandering the streets of Ocala in a robe and sandals. Be straight with me, okay?”
Brianna looked down, as though her shoes had become suddenly fascinating. “There are several other, less serious conditions we need to consider. But if it is ALS…the standard prognosis is progressive debilitating physical—but not mental—decline, resulting in complete respiratory paralysis, and death,” she said. Then she looked up, eyes full of sympathy. “But I cannot stress enough that we might be looking at some other neuromuscular situation here.”
“Oh, joy.”
“Have the tests, and let me see if Andre Bolin can make time for you tomorrow.”
“Sure,” Meg said. “That’d be—gosh, that’d be great.”
Twenty-three
CARSON APPROACHED THE DOOR TO THE SHED SOLEMNLY, GLAD THAT VAL and Wade had planned a two-hour endurance run for her workout. He wanted time alone here before he let Val see the place—and he’d have to let her see it. They were going to be married, which meant letting her into every part of his life, or so he believed marriage was supposed to require. Whether he could allow her to tour the darker, less concrete places remained to be seen. After that strange, awkward meeting with Meg earlier this afternoon, he was starkly reminded of just how much there was to him that Val didn’t know. Nothing about Meg, or how long he’d waited without hope before moving on.
Two years. He didn’t know any other guy who, once he’d lost his virginity, had remained celibate for so long. But he just hadn’t been…willing. Even his first encounter after Meg, with Lisa Kline, a high school classmate of theirs, wasn’t something he’d sought out.
She’d bought him a beer after a set one Saturday night when the band, newly assembled, played a dive bar in Jacksonville.
“I thought that was you!” Lisa said. Her hair was blonder and her breasts bigger, but she looked otherwise the same as she had when they’d all been in Lou Davis’s trigonometry class together.
“It’s me, all right,” he said. He’d thrown down a few Jack and Cokes already; he wasn’t his most articulate.
She smiled, that big, friendly, I-screw-the-band smile he would become too familiar with in the months and years to come. “You guys are just so great. I mean, way better than I usually see here.” She swigged from her own long-necked bottle and wiped her mouth. “What are you doing after?”
He’d thought he was going back to the roadside motel with George, but instead he went out back with Lisa. They’d kissed, sloppily, both of them glassy-eyed, and then Lisa pulled her denim skirt up around her waist and leaned over, putting her hands on the edge of the wooden landing.
He just stood there, looking at her tanned ass with its thin, white Y of a tan line.
“Come on, baby; you know what to do,” she said.
He did. He moved behind her and dropped his jeans.
As soon as she’d gone, he curled up on the steps and passed out. That was the start of his post-Meg love life, the first of many indignities dulled by binges of alcohol or drugs. Thank God he was done with all that.
The broad arms of an ancient cypress tree stretched overhead, filtering late-afternoon sun that dappled the scrubby path beneath his bare feet—dappled his feet, too, and arms and shoulders…he stood still and watched the play of shadow and light on his forearms, the motion provoking a new melody in his mind, distant and faint but worth paying attention to. Songs came to him in all sorts of ways; once he’d been entranced by the low drone of a prop jet’s engines, which had translated into a song one critic described as “hypnotizing and erotic.” Another time the germ of a tune came from the shush of rain pelting the canvas patio awning at his Seattle condo, which he’d be vacating permanently next week.
The melodies would whisper to him for days or weeks or even months, sometimes, and build on themselves, become fuller and more dynamic, and then the lyrics would begin to come, as if in response to whatever the music had stirred in him. He’d been writing music long enough to recognize the process, to understand how the songs were reflections of his psyche; any musician who claimed to be able to make music on a lark was either bullshitting or creating soulless pop music as disposable as tissues.
Humming, he put his hand on the shed’s doorknob, turned it, and pushed. Humidity had swelled the wooden frame and the door stuck stubbornly at first, then gave way, opening into the dim, musty-smelling front room. First he simply peered inside, leaning in with his hand on the doorframe. If anyone had been in there since 1990, he couldn’t tell. The room appeared exactly as he’d left it, as if he’d stepped out to take a turn driving the tree shaker, or go pick up a pizza. He and Meg had gone for pizza scores of times, the two of them hopping into his Ranger pickup, its door panels rusting out, and getting an extra-large pepperoni and mushroom takeout from a little pizza shack at the corner of the highway, inexplicably named Vladimir’s.
God, she was beautiful at eighteen…she’d hated her freckles, wished for curly hair and bigger breasts—women were never satisfied with their looks—but he wouldn’t have changed one spot or strand, had no desire for her to be anything other than who she was. They would take the pizza upstairs, feed each other, and he would get distracted by her bottom lip as he brushed it with his thumb, or the way she licked sauce from the corners of her mouth. She’d laugh at him, tease that he was a sex fiend—and at nineteen he was, of course. But he’d believed with every cell that his lust and love for her were inseparable, inspired by the perfection of their physical, mental, and emotional fit.
Closing the door behind him, Carson stood on the multicolored rag rug and let the memories wash over him: Meg at the table in only his T-shirt, eating scrambled eggs he’d cooked for a late dinner, telling him all about her first day of college—junior college, before Brian, before she’d transferred to U of F; Meg up on a ladder with hammer in hand and nails in her mouth, nailing window trim; Meg asleep on his bed, her accounting textbook—the epitome of boredom, she’d said—facedown on her chest; Meg coming upstairs the morning of her wedding, renewing, then dashing, his last remaining hope—he’d felt at first that he’d willed her there that morning, a specter conjured from his longing and frustration and anger. And maybe he had. Now he thought maybe if he’d just gotten over her right away instead of carrying a torch for those eighteen months, she’d have had no power over him that morning, or any time since.
This cascade of history, this waterfall of plans made and futures imagined then destroyed, was exactly what he’d feared would come if he went into the shed—and was why he’d avoided the place every time he visited before. He knew his mom was waiting for him to clear it out when he was ready—and he hadn’t been ready. Plunging into the past today was healthy, though. Necessary. It was only right that he go to Val whole.
If he could.
He moved through the front room and then the kitchen, touching the surfaces, recalling the textures of the four years he’d lived there before leaving for good. The kitchen table, made from a door salvaged from some other farm, sanded and painted by Meg, later witnessed many long nights of
coffee and bourbon and his pitiful beginnings at writing the songs that had begun lodging in his soul. He’d started on guitar, which he’d been playing somewhat poorly for years. When he began to see his potential, he brought in a piano that had belonged to the widow who lived up the road, past the Powells’.
That piano was the only thing he’d moved from here, having it sent first to his tiny Los Angeles apartment, then to the San Jose house, and finally to his Seattle condo—where it would soon be crated and moved to the house he and Val were buying in Malibu. He thought of how, in his escape from Florida, he’d gone as far away as he possibly could go and still pursue the music. As if three thousand miles were enough to buffer his awareness of Meg’s presence, of her promise to love another man till death did them part.
He opened each of the six cupboard doors, all of them painted a robin’s egg blue that she’d said would contrast well with the honey-stained pine of the floors and walls. Though the cupboards were mostly empty, vestiges of his bachelorhood still remained: a box of Frosted Flakes, three cans of baked beans, spice tins of curry and red pepper flakes and saffron. His Seattle kitchen, outfitted with every gourmet ingredient and gadget, would sneer at this humble assortment of foods and the three aluminum pots that had served every culinary need at the time.
He would miss his condo, the murky but soothing light of the damp afternoons, gray-blue with a shimmery wash of orange as the sun dropped toward Puget Sound. The sunny Malibu house, fabulous in its linearity, its glass expanses overlooking the ocean, was so exposed, so energized. It suited Val perfectly.
She loved those edge-of-the-land spaces. They were in her blood, part of her character. She loved the kinetic vibe, the daringness of a house perched on a cliffside—like her at the crest of a towering wave. Val was a woman always ready for adventure, and he admired this in her beyond all. Admittedly, he was more vibrant in her company; he’d found the experience of running with her and her gang a real charge, in the beginning. It wasn’t sustainable for him, though, and he’d told her as much. “So you’ll just, like, join in when you’re in the mood,” she’d said, unperturbed. That was another thing he admired: her independence. She didn’t cling—which was good, but he had to admit that a little bit of clinginess might be nice, just every now and then, just enough to make him feel…essential.
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