Hard Knocks

by Ruby Lang

  No patients.

  Well, no, there was one patient, right here, right now, with molten brown eyes framed by silver glasses. He glared at her as if she had already plunged a syringe into his arm. She wondered how long he had been sitting in her waiting room, and why she hadn’t heard him come in. Somehow, somewhere, she needed to locate a scrap of professionalism.

  She took a deep breath and reminded herself that she was the physician. She was in charge and she had some big needles. “You’re here for an allergy screening, is that right, Mr. Zamora? I’m sorry there wasn’t anyone to greet you today. My receptionist must have stepped out.”

  That wasn’t exactly the truth. Business was so slow, Petra could only spring for a part-timer named Joanie who studied acting at the Willamette Academy of Drama. Joanie read from the complete works of J.R.R. Tolkien when the phone wasn’t ringing—which was almost always. So, yes, the receptionist had stepped out.

  For the rest of the week.

  The Two Towers still lay on Joanie’s desk.

  Ian Zamora was making Petra so nervous that she was lying.

  Petra put on a perky smile. She noticed that he waited until she sat down. Good manners, nice hair, great deltoids, she told herself, then tamped down the thought immediately.

  “Maybe I should tell you a little bit about the test. It’s called an allergen-specific IgE panel,” she said, straightening her spine.

  As she spoke, she cast her trained eye over the patient. Fit, she thought. Lean. Tall. Dangerous.

  He’s a patient, she reminded herself before her thoughts meandered in an unethical direction. Fibulae, tibulae, T cells, and lymph nodes, pecs, those deltoids again—well-developed deltoids outlined subtly under a tailored, blue button-down—beautiful, long quadriceps under his jeans. A runner maybe? He was certainly rangy but gifted with a graceful elasticity that was evident even in the way he walked and sat down. She shied hastily from that thought. An image of Hippocrates, the father of western medicine, appeared in her head. He waggled his finger and tried to make himself heard over the shrill voice of Petra’s hormones. Do no harm, he intoned, and quit ogling your patient. But really, did this Ian Zamora have to have such piercing brown eyes? Did he have to have knife-like cheekbones?

  “Um, did you need me to fill out any paperwork?” he asked, shifting his athletic frame in the chair.

  She gave a startled jump. Christ, she’d forgotten about the insurance forms. She straightened and tried to look like she’d been doing this forever and that he wasn’t one of the first patients in her practice.

  Maybe he hadn’t noticed. “You can fill it out while we’re waiting for the results of the test,” she said. “It’ll keep your mind off things.”

  “That’s actually a good idea.”

  “Hum. Yes. Well, let me get a few more of your particulars, Mr. Zamora.”

  “Ian.”

  “Right,” she snapped. “Ian.”

  She took out her smartphone and began asking him the standard questions about medications. The next moments flew by. She felt soothed by the familiar rhythm of the exam. She loved being a doctor. Even the routine things felt good: washing her hands, listening to heartbeats and checking blood pressure, pricking and marking the skin. It was the peripheral stuff—filling out insurance forms, figuring out the copays, even just talking to her receptionist (when she was there)—that threw her for a loop. She took out the panel and settled it into his skin, then withdrew it carefully. She gave him his paperwork, took his insurance card, and told him she’d be back in a few minutes. In front of the photocopier, she held her head between her hands.

  Six years of med school, hundreds of thousands of dollars in debt. Now, Petra was standing in front of a combination fax/copier/printer that she barely understood. She stabbed at a button with her finger. It worked! You are awesome! she told herself.

  It was the little things.

  She looked around her. The honey-colored floors of the office were unscuffed by feet, and the coffee table shone glossily at her, polished to within an inch of its life. There was no dust lurking in the corners or curling under desks. She had beautiful equipment: an automatic blood pressure cuff, a customized records system, a USB spirometer that plugged into her laptop, a slim, European medical refrigerator with rows of tiny bottles filled with allergens. Her office was perfect. It was everything that she had ever dreamed of. Except…

  Except, if she didn’t start getting patients soon, she would tear through her savings and the money her father had left her. And if she lost all of her nest egg, she’d definitely have to close up the office. She rubbed her forehead. She would have to go work at Pronto!Docs, known among her classmates as The Factory, a multi-armed practice with offices in malls across the city. A couple of her medical school buddies worked there and they loathed it. Patients shuttled through the offices as if transported in and out on conveyor belts, and physicians acted like prescription-writing machines. But business poured in regularly and everyone got paid, which was far more than Petra could say for her own modest office.

  She took a deep breath. She could stick out this early dry spell. She had a few patients. Ian Zamora could potentially be another. She just had to be friendly, helpful, and knowledgeable. Professional. She knocked on the office door and let herself in, then scrutinized his forearm. She touched his skin gently and for a moment, they were silent.

  “Looks like you reacted to the dust,” she said, blinking. “Cats, too. But that’s all.”

  She took her hand away.

  “I want the shots,” Ian Zamora said, delivering the line with the coldness of an aristocrat. His eyes behind his glasses were inscrutable.

  Was this guy for real?

  “Uh, yes. Well, we can book them for your next visit, but first, I should probably discuss some of the options open to you,” Petra said, pursing her lips to keep from an irrational urge to laugh. “Immunotherapy—the shots—will certainly lessen your reactions. But you’d have to come in once a week for the jabs and stay here for at least half an hour afterward so that we can monitor your reaction. It takes a long, long time—some people do this for years. And since you’re only really allergic to dust and cats, you might be able to control the reaction with medication and avoidance of allergens.”

  Ian Zamora cleared his throat. “So if I understand you correctly, Doctor, you’re actually trying to discourage me from coming here, week after week for a year or more, for your services?”

  “I’m just trying to make sure you know all your options.”

  Ian Zamora shook his head and the beginnings of a smile finally began to play on his face. “That is what we call bungling the upsell.”

  “What does that mean?”

  “It means that you should try to convince people to use the full extent of your services, no matter what.”

  His face changed suddenly and his voice dropped into the discreet tones of a waiter. “May I suggest a bottle of the 1927 Grapé de Welch’s to go with your entrée, ma’am? Our sommelier can recommend a wine pairing for your salad. Dessert? Coffee? Tea? Dessert wine? Cookie plate? Surely a woman of your beauty hardly need watch her figure. An aperitif to go with your crème brulée, perhaps?”

  “I’ll take it all,” Petra said dryly. Then she flushed. She wasn’t here to joke around. “But it’s not really the same thing. I’m not out to make piles of cash off of people’s ailments. Although I do need to start thinking of it more as a business. But my main duty is to make sure that patients stay well and, I don’t know, live to come in another year. I don’t believe in making people do something completely unnecessary and potentially harmful.”

  Ian looked wry, and a dimple appeared at the corner of his mouth. “So earnest. You’re new at this, aren’t you?”

  “How can you tell?”

  “The last doc told me I was allergic to ragweed, oaks, elms, dogs and feathers, and twenty different kinds of flowers. She recommended that I come in for a whole fusillade of needles, prickles, and oint
ments and pills. She wanted me to buy four different medications, and she told me we should do some food allergy testing. I balked, of course. Until now, I hadn’t seen a reason to do anything about my allergies.”

  “Well, I’m not saying that she’s wrong about your other sensitivities,” Petra said carefully. “But some physicians find it, um, worth their while to err on the side of caution.”

  This time, Ian Zamora gave a real laugh. His eyes crinkled at the corners and his mouth opened wide to reveal slightly snaggled teeth. It was appallingly charming. Petra felt the full force of it in her solar plexus. “You’re not saying she’s wrong, but you are trying to find a nice way of telling me that she was full of shit,” he said.

  “If we must use layman’s terms.”

  They exchanged a long look.

  “Well, I want to receive the full, long treatment, Doc. I won’t avoid cats because I have a special fondness for crazy cat ladies. My girlfriend is one.” He smiled at Petra for some unspecified reason. “And nothing’s going to persuade me to clean under my couch. I’ve got a little dust-bunny commune going there. They’re like my roommates.” He paused, and glanced at Petra almost coyly. “I’ll bet your place is immaculate.”

  Underneath the glasses, he had long lashes.

  Petra grimaced. “Uh, no, my place is not immaculate. Why would you think that?”

  “I guess I imagined it would be like this office.”

  They both glanced around at the shiny floors and Petra’s bare desk. The glass and steel refrigerators hummed quietly in their corner. Petra laughed again even as she felt a little pang. “It’s very spartan, isn’t it? But it is supposed to be a place of business. It doesn’t reflect who I am.”

  Not that she cared who he thought she was under the white coat, of course.

  He quirked an eyebrow, which caused Petra to stop breathing.

  “No, I suppose not,” he said. “Besides, I hate to think what my office says about me.”

  Don’t ask him any personal questions. He was clearly too dark and intense and masculine for the likes of her. It wouldn’t inspire confidence if the allergist began hyperventilating in her own office. She turned away to hide her blush, and let out a small stream of air from her nose. “Okay, because you’ve decided you want to come in for the full course of shots, let me write out a couple of prescriptions and set up the first appointment for you for next week.”

  Rattling off instructions about nasal spray and pills helped restore her competence, in her own mind at least. She loaded his arms with leaflets about immunotherapy and a pile of samples, and practically pushed him out the door.

  When he was safely gone, she sat down in one of the waiting room chairs. Her body tingled. She had never had this kind of reaction to a patient before. She hoped it would get better over time.

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