Chapter 12

It’s never good when you take a patient’s blood pressure and you gasp when you see the result.

We do have an automatic blood pressure cuff on Primary Care C. It’s our one luxury, in addition to, I guess, running water and electricity. I guard that cuff with my life. So when I’m taking eighty-two-year-old Joseph McAuliffe’s blood pressure and the result reads 238/115, I assume the damn machine must finally have broken on me.

Well, at least we still have electricity and running water.

“What’s wrong?” Mr. McAuliffe’s daughter asks me. “Is that high?”

Is that a real question? I mean, even if you don’t know the medical association’s recommendations for blood pressure control, you’ve got to recognize that a top number of 238 is not just high, but really freaking high. Like, let’s get you to the ER before you have a stroke kind of high .

“I’m going to recheck it manually,” I tell them.

Except when I recheck it, the number is similar. This man is dangerously hypertensive.

I’m getting ready to tell the McAuliffes that I’m going to have to call the ER when I happen to notice a note from the last time Mr. McAuliffe was seen in clinic. His blood pressure then was 223/110. And it was similarly high the time before that.

So this is normal for him. He’s probably headed for a stroke or heart attack or something else bad, but not in the next day. Eventually though.

“Have you been taking the medications I prescribed for your blood pressure?” I ask Mr. McAuliffe.

“Eh?” Mr. McAuliffe says.

Approximately ninety percent of my patients are deaf. That’s probably why every patient with normal hearing keeps asking me why I’m screaming.

“I have his medications here,” his daughter tells me.

And then she pulls out The Sack.

The Sack refers to the giant bag that some large percentage of elderly people toss their pill bottles into. Then, as far as I can tell, they just reach in to take whatever medication they randomly pull out. I hate The Sack.

Mr. McAuliffe’s sack is a big black garbage bag. I start rifling through it, pulling out half-filled bottles of pills. Before I’m done, I’ve lined up two bottles of amlodipine, three bottles of atenolol and four bottles of hydrochlorothiazide, all blood pressure lowering medications.

“Do you help him with his medications?” I ask the daughter.

She shakes her head. “No, he can do it himself.”

“Mr. McAuliffe.” I face my patient, who is scratching absently at a scab on his balding scalp that is probably skin cancer. But one thing at a time. “Are you taking pills from all these bottles?”

Mr. McAuliffe stares blankly at the bottles. “No, just the ones I’m supposed to.”

“He knows what he’s doing,” the daughter assures me.

“Mr. McAuliffe,” I say again. “What month is it?”

“Uh…” He thinks for a minute. “June? Or is it July yet?”

The parking lot is literally coated in snow. I glance at the daughter, who looks slightly pale.

“And what year is it?” I ask.

“It’s…” He thinks again, finally trailing off and possibly forgetting my question.

“What year is it?” I press him.

He scratches his skin cancer again. “It’s 1967, I think. ”

“Oh my God,” the daughter murmurs. “He’s been paying his own bills too. No wonder the power got shut off!”

I extract a solemn promise from Mr. McAuliffe’s daughter to supervise her father on his medications, although we have to start from scratch considering we don’t know what he’d been actually taking. She seems to understand how serious the situation is. Daughters are usually good in that respect. When you get old, it’s way better to have daughters than sons. Daughters usually take care of their elderly parents. Sons, less so.

It’s not a surprise that the next patient on my list is Herman Katz. It’s been a whole week and a half since his last visit to see me. That might be some kind of record. Under reason for the visit, it says, “Worried about arms.”

Huh. That’s a new one.

“So what’s going on, Mr. Katz?” I ask him.

Mr. Katz slumps forward on the examining table. His gut strains slightly against the fabric of his gown. “I’m really worried, Dr. McGill.”

I put on my most concerned and caring expression. “Why are you worried?”

“Well…” He takes a deep breath, the crease between his eyebrows deepening. “When I walk, I just feel like… like my arms are rubbing against my chest. I mean, a lot more than they used to.” He bites his lip. “I think… could it be cancer? ”

“I don’t think you have cancer,” I say.

I see some of the tension leave his face. “Really? Then what could cause that?”

“Um.” I cross my legs. “Mr. Katz, you’ve gained about twenty pounds since your wife died, haven’t you? Maybe the extra weight is why your arms are rubbing against your chest.”

His eyes widen. “You really think so?”

“Definitely.”

“But I’ve felt… tired.” He shakes his head. “Really tired.”

I raise my eyebrows. “You’re tired all the time?”

“Not all the time, no,” he says. “Just when I use my computer. To do the email.”

I stand up from my stool. “You don’t have cancer, Mr. Katz. You just need to lose a little weight.”

He’s so incredibly relieved that he can’t stop shaking my hand and thanking me. Well, even if everyone else in the world hates me, at least Mr. Katz likes me.

After Mr. Katz leaves the room, I notice that we are not only out of clean gowns, but the laundry basket in the room is absolutely overflowing. In the past, housekeeping has always emptied it, but somehow it hasn’t happened recently. Maybe I was supposed to tip them at Christmas?

I’ve got five minutes before my next patient. I walk down the hall, where Barbara is affixing fake nails onto her real nails. I’ve never seen a person so interested in nail care—mine are bitten to quicks. For a short time between graduation from residency and the birth of Leah, I had nice, healthy nails. But that’s a distant memory.

“Barbara,” I say. “The laundry basket in my examining room is full. And I don’t have any clean gowns in there.”

Barbara looks up at me with her mascaraed eyes. “It’s not my job to take care of that.”

“Well, could you please call housekeeping then?” I ask. “I need to finish documenting before my next patient.”

“It’s not my job,” she repeats, more firmly this time.

I sigh. “Is there any chance you could talk to them as a favor to me?”

“It’s not my job,” Barbara says, like a robot who’s gotten stuck in some circuit loop.

“Fine,” I say, more angrily than I intended. Or maybe just as angrily as I intended.

I’m furious at Barbara. She is the most useless person on the entire planet. Her entire job is somehow just to check off boxes on a piece of paper, and she doesn’t even do that right half the time. Yet no degree of laziness or incompetence will be enough to get her out of here. Lisa always says that it’s almost impossible to get fired at the VA. The only way to do it is to make babies with a dead patient… twice. “Because the first time, you’d only get a warning,” she told me .

I march out of the waiting area. I don’t have much time before my next patient, but I need gowns. I peek in all the open exam rooms, but they all appear to be barren. Damn it.

Finally, I decide to call housekeeping. I punch in zero for the operator and wait an agonizing two minutes before a bored-sounding voice answers, “Hello?”

“Can you transfer me to housekeeping?” I ask.

I hear some shuffling of papers, and for a moment, I’m terrified that the operator will announce that it’s not her job to do that. Finally, without further explanation, I hear ringing on the other line. I wait through half a dozen rings before I hear a recorded voice: “You’ve reached the housekeeping department…”

I look at my watch. I don’t want to be late to seeing my next patient, but I’ve got to have new gowns and I also don’t want an overflowing basket of laundry in my room. Maybe I can run down to housekeeping in the basement and be back in just a few minutes.

Well, it’s not like I have much of a choice.

The laundry basket is on wheels, so at least I’ve got that going for me. But it weighs about a thousand pounds. Still, once I start pushing it, it’s not so bad. Maybe after I take it down in the elevator, George the elevator guy can help me push it to housekeeping.

(That was a joke. )

I push the button for the elevator and wait patiently, making calculations in my head to determine whether the cart will fit through the elevator doors or if I’ll have to use the service elevator. That’s when the doors swing open and none other than Ryan Reilly is standing before me.

Great. Just what I need. To get mocked by Ryan.

His blue eyes widen when he sees me with the basket full of dirty gowns. “What are you doing ?”

“I couldn’t get ahold of housekeeping.” I can’t even meet his eyes. “We’re all out of clean gowns.”

Ryan steps out of the elevator. At first I think he’s going to help me load the cart into the elevator, but then he lets the doors close behind me.

“What about your receptionist?” he asks.

I shake my head. “Barbara says it’s not her job.”

“Jane,” he says, “I don’t know why I’m the one who has to tell you this, but it’s not your job to take the laundry down to the basement.”

“Well, nobody else will do it.” I try to keep the bitterness from creeping into my voice. “So it’s got to be me.”

“Yeah, we’ll see about that.”

Ryan seizes the laundry basket and shoos me away to push it back to Primary Care C. I hurry after him, nervous about what he’s going to do, but also glad that maybe I won’t have to do the laundry. I swear to God, there was a reasonable chance that if I went to housekeeping, they’d make me wash the gowns myself.

Ryan pushes the cart all the way to the waiting area, then steps inside to find Barbara still hard at work on her nails. He clears his throat once, loudly, then she looks up.

At first Barbara looks horribly irritated by having her nail ritual disturbed. But the second she realizes who’s standing in front of her, the sour look on her face disappears and is replaced by a smile that I’ve never seen before.

“How can I help you?” Barbara asks sweetly.

Ryan rewards her with a sexy smile. “Hi, Barbara. I’m Dr. Reilly.”

“Well, it’s a pleasure to meet you, Dr. Reilly,” she coos.

“So we’ve got a problem here,” he says. “Dr. McGill is unable to reach housekeeping and we’ve got to get this laundry downstairs and some new gowns upstairs. ASAP.” His smile broadens. “Any chance you could help us out?”

“Of course!” Barbara jumps out of her seat so fast that it nearly falls over. She pushes past me, shooting me a dirty look, then grabs the handles of the basket. “I’ll be back in a jiffy!”

And just like that, Barbara takes the laundry down to the basement. I wouldn’t believe it if I hadn’t seen it with my own eyes .

“See?” Ryan says to me as I walk him into the hallway. “That’s how it’s done.

“You seem to forget,” I say, “that I’m not a super handsome surgeon.”

He grins at me. “You think I’m super handsome.”

I feel my cheeks grow warm, which means I probably resemble an apple. “I just meant, you know, in a general sort of way.”

“Nope, too late.” He’s still grinning. “Can’t take it back. Although it doesn’t explain why you won’t meet me for lunch.”

I texted Ryan back a quick apologetic negative to his lunch request. And his second lunch request. And his third.

“I’m just very busy,” I say.

“It’s not like I’m asking you to meet me in the call room, Jane.” He lowers his voice a notch. “Although we could if you wanted.”

During residency, Ryan and I desecrated nearly every single call room. Mostly it was out of necessity—at least one of the two of us was always in the hospital. And there were a lot of times we couldn’t wait till we could get to either of our apartments. I remember kissing him on that tiny, creaky twin bed in the call room as we pulled off our clothing, hoping neither of our pagers would go off.

Those were nice times.

“I just don’t think it’s a good idea,” I say .

He raises one eyebrow. “The call room?”

I stare at him. “No! I mean, yes. The call room isn’t a good idea. But lunch isn’t a good idea either. My husband wouldn’t… you know…”

“Oh.” He looks down the hallway at the elevators. “So Pip doesn’t approve of us being friends then?”

“I just don’t think it’s a good idea,” I say again.

What I don’t say is that I don’t trust myself with him. I don’t say it because it sounds so stupid. I’m a grown woman—married with a daughter. How could I not trust myself with some arrogant surgeon?

But the real reason I don’t say it is because he already knows that it’s true.