Chapter 25

It took me three hours of tossing and turning in bed to fall asleep. In the beginning, I couldn’t sleep because I was too fired up with anger and adrenaline. I kept thinking of things I wish I had said to Ben, although I have a feeling that none of those things would have made the situation any better.

Then after the first hour, the anger turned into concern. Where was he? What kind of hotel was he staying at? Was it some crazy Motel 6 where he was going to get himself murdered? He should have just slept in our spare bedroom.

I kept looking over at Ben’s empty side of the bed. There have been very few nights in our entire marriage that we’ve spent apart. It’s hard to sleep without him next to me. Even though I sort of hate him right now.

At some point, I must have drifted off into a restless sleep, and when I woke up in a cold sweat at five in the morning, the bed was still empty. I stared at the left side of the bed for several minutes, then closed my eyes and tried to go back to sleep.

When I finally got up in the morning, feeling like a truck had run me over, I discovered Ben asleep on the couch in the living room, snoring softly. I didn’t know when he had come home, but perhaps he decided not to abandon his family after all. Or maybe the hotel he went to had bed bugs.

In any case, I decided not to wake him up. After all, there was nothing I had to say to him.

Right now, I’m trying to do my job even though I feel (and certainly look) like complete shit. I’m avoiding Lisa, because I know the second she asks me what’s wrong, I’m going to burst into tears. But I’m not performing at my best. My shining moment of the day was when I was trying to call the lab to get the results of a urinalysis I ordered. The first time I called, I wasn’t paying enough attention to the phone menu, so I selected the wrong option. I called back, but this time I dialed the wrong phone number altogether. I called back again and listened to the message, but accidentally pressed the wrong option number again anyway. I called back again and this time didn’t listen to the message, but accidentally pressed the wrong option number once again. Finally, on the fifth try, I managed to get through to the lab.

At some point, I started to wonder if none of this was real and I was dreaming the whole thing. That’s something that has happened to me before in dreams—I’ve been trying and trying to dial a number and just can’t dial it correctly.

Maybe all of this is a dream. Maybe Ben never told me he was seriously considering leaving me.

The worst part is that today is my evening clinic day of the month. Ben picks up Leah today because I have patients booked until eight at night. It’s horrible. I hope he actually picks her up—I should probably text him to make sure, but I figure that Mila will most certainly be contacting me if he doesn’t.

The patient I’m seeing right now is sapping every last bit of my strength. His name is Sam Powell and he’s an OIF vet. I actually see a lot of younger men in clinic thanks to the most recent wars overseas. Operation Enduring Freedom was the war in Afghanistan that started in 2001 after the World Trade Center bombings. Then two years later was Operation Iraqi Freedom (OIF). Between the two wars, there’s a huge influx of young veterans, many of whom are messed up in the head from their experiences watching their friends get blown to bits by Improvised Explosive Devices, also known as roadside bombs. Some of them are fine, but Sam Powell is not.

Mr. Powell has a bad case of Posttraumatic Stress Disorder. It’s not uncommon in vets who have seen some of the awful things that he’s seen. I think he had issues before though, and going off to war only made him worse. I don’t know everything that’s happened to him—that’s a matter for his psychiatrist to address. But I do know one thing: a lot more psychiatrists and psychologists are desperately needed here at the VA. There’s only so much I can do for this guy as his primary care doctor.

“I need to be tested,” Mr. Powell tells me. “For, you know, STDs.”

“Oh,” I say quietly. It isn’t an uncommon request in my younger patients. “Any STD in particular that you’re concerned about?”

Mr. Powell takes a deep breath. He’s so thin that he’s scrawny, although I can’t imagine he was that way when he first went off to war. He keeps shifting on the examining table, unable to make eye contact. I’m convinced he’s got another psych diagnosis beyond PTSD. I’m no psychiatrist, but I know paranoid psychosis when I see it.

“So here’s the thing,” he says. “I was in this public bathroom, you know? Like at a rest station. And they had no toilet paper. But I had to wipe myself. So I found this newspaper on the floor of the bathroom and I used that to wipe.” He runs a shaky hand through his short hair. “I think I might have gotten some disease from the newspaper. So I want to be tested. For everything. Chlamydia, gonorrhea, AIDS—everything.”

“Mr. Powell,” I say as gently as I can. “You can’t get an STD from a newspaper. ”

“You’re wrong.” His fists clench. “I think I did. And I want to be tested.”

“Okay…” If he wants to be tested, I’m not going to deny him that. Maybe this is all a story so that he doesn’t have to tell me about a recent orgy. Although I genuinely think he’s telling me the truth. “I can test you right now, if you’d like.”

He shakes his head firmly. “No, not here. Give me the test and I’ll do it at home.”

I’ve never heard of a full STD panel that can be run in the comfort of a patient’s own home. “I’m sorry, but I can’t do that. The tests have to be done in the office and also a blood test in the lab.”

“No.” He grits his teeth. “I can’t do that.” His voice raises a few notches. “I want to do it at home.”

I look at my patient, wondering if I need to be worried for my safety. Probably not. But wouldn’t that be a perfect end to my day? To get strangled by a crazy guy who wants a home gonorrhea kit.

“How about this,” I say to Mr. Powell. “I’ll do a physical exam and if it looks like you have any signs of a sexually transmitted disease, then we’ll run the panel. Otherwise, I don’t think you need to worry. Okay?”

That seems to placate my patient. His shoulders relax slightly and he lets me examine him. And there’s no discharge or suspicious lesions that would make me think that his encounter with the newspaper was anything other than benign. So I send him home with a clean bill of health.

Just as Mr. Powell goes on his way, I get a page from Ultrasound, which has never happened to me before during my short tour of duty at the VA. When I call the number, a breathless voice answers: “Dr. McGill?”

“Yes, this is Dr. McGill,” I say. Wow, they were actually waiting by the phone. Half the time when I return my pages around here, the person calling has taken off by the time I dial the number, probably having gone home for the day.

“This is Liz—an ultrasound tech,” an unfamiliar voice informs me. “I have a patient of yours down here. His named is Ray Chambers.”

“Yes.” I saw Ray Chambers early this morning. He presented with right leg pain and I noticed his calf was warm and tender. So I booked him for an ultrasound, thinking that the last thing I’d want to miss was a blood clot in his leg. He’d been reluctant, but finally agreed to get the test.

“So he’s got clots in both his right femoral and popliteal veins,” Liz tells me. “They’re pretty extensive clots, going all the way up to the pelvis.”

“Geez,” I breathe. Good thing I convinced the guy to get the study. A blood clot in the leg, also known as a deep venous thrombosis, is potentially fatal. The clot could travel up to the lungs, resulting in a pulmonary embolus, which could easily be fatal. He needs to be treated with a blood thinner, and my first choice would be to send him to the emergency room.

“The problem,” Liz tells me, “is that Mr. Chambers is not excited to stick around the hospital—I definitely can’t convince him to go to the ER. He keeps saying he wants to go home, and he’s obviously competent to do so. We’ve convinced him to stay though, just to talk to you, and I’m going to have someone wheel him up to your clinic as soon as we have an orderly available. It will probably be in the next ten to fifteen minutes.”

“Great, thank you!” I say. “That’s awesome. Thank you so much.”

“It’s no problem at all.” Liz seems befuddled by my rush of gratitude. It just amazes me lately when the staff at the VA actually does something to help me. I’m genuinely shocked they’re not making me come down there to retrieve Mr. Chambers myself. “Just have someone waiting there, because he’s a flight risk.”

The problem with that is I’ve got a heavily booked schedule for the day. I don’t have time to be waiting around at the entrance to Primary Care C for Mr. Chambers to arrive. This is one that I’m going to have to count on Barbara to do.

I sprint over to the waiting area, where Barbara is in the middle of putting a final coat of fire engine red on her nails. There are two patients sitting on chairs, and I think both of them are mine—I’m really behind. But I need to make sure Mr. Chambers is safe.

“Barbara,” I say.

Barbara finishes two more of her nails before she speaks to me. “Hang on.”

She dips her brush back in the bottle of polish and finishes up the rest of the nails on that hand. I wait patiently, assuming she’s going to look up and talk to me after that, but instead she starts blowing on her nails.

“Barbara!” I say, more sharply this time.

Finally, she looks up. “Yes?”

I glance at the two patients in the room. “I need to talk to you about a patient. Can we go outside?”

Barbara sighs heavily, but reluctantly traverses the two yards to just outside the door. I lower my voice so that nobody can overhear. “There’s a patient named Ray Chambers who has a large blood clot in his leg,” I tell her. “Ultrasound is sending him up here in maybe ten or fifteen minutes, and I need you to pull me out of the examining room as soon as he arrives, okay?”

Barbara frowns at me. “It’s not my job to get you out of the room. I just check in and schedule the patients.”

I take a deep breath, trying not to get frustrated with her. “Barbara, this is really serious. I need you to get me from the room when he comes. It’s important . He could die if he doesn’t get treated. ”

She chews on her lip, thinking it over. I swear to God, I don’t see what the big deal is. I’m not asking her to walk to the moon—I’m right down the hall!

“Actually,” she says, “I’m taking a break in a few minutes. So I probably won’t even be around when the patient arrives.”

“Can’t you take a break later?” The exasperation is creeping into my voice.

“The doctors don’t dictate when I get to take my breaks,” Barbara snaps at me. And with those words, she goes back into the waiting room and plucks her purse off her chair. She’s leaving. Oh my God, she’s leaving. What the hell? She hasn’t even finished her nails!

And then something snaps inside me. I may not be able to control what my husband does, I may let the elevator guy humiliate me on a daily basis, but I’m not going to allow this woman to compromise patient care for no other reason than pure laziness and possibly spite. This is her job .

“Barbara,” I say in an even but firm voice. I stand in front of her to block her from leaving. She’s roughly my height, although I suspect in a one-to-one, Barbara could take me—she looks feisty. But right now, I’m madder. “You’re not going anywhere . You’re staying right here to wait for that patient.”

She squints at me. “It’s not my job to— ”

“Actually, it is your job.” I stare her right in the eyes. “Your job is to wait here and check in patients. And if there’s an issue with a patient in the waiting area, it’s your job to tell me about it. And if you leave here right now when there’s a life or death issue, you’re failing to do your job .”

Barbara opens her mouth to say something, but I cut her off, hissing, “I swear to you, Barbara, if any harm comes to this patient because you left when I told you that you need to stay, that is criminal negligence . You get me? And believe me, I will hold you personally responsible.”

Her heavily mascaraed eyes widen.

“I will go to your boss and your boss’s boss and everyone in the entire goddamn hospital if I have to.” I squeeze my hands into sweaty fists. “So if you’d like to keep working here, I think you better stay and do your goddamn job .”

Barbara is staring at me, her lips forming a little “O.” I don’t think she expected me to say all that. She hesitates, clutching her purse to her chest, maybe trying to figure out if I’m serious. Finally, she says, “Well, if it’s a matter of life or death, of course I’ll stay.”

And then she goes back to her desk and sits down.

I can’t believe that worked! I always thought if I yelled at Barbara, she’d just give me the finger and leave. But she’s now back at her desk like a good little worker. She isn’t even doing her nails !

Wow. Maybe I’ve been living my entire life wrong. Instead of being nice to people, I ought to be threatening them and bossing them around. It sure works for Ryan. It works for a lot of physicians I’ve met. Maybe if I were more forceful with Ben, he wouldn’t be threatening to move out. Maybe Leah would be potty trained by now.

I look down at my hands, which are shaking like leaves. My heart won’t stop pounding and my legs feel like jello. Who am I kidding—this isn’t me. I can whip out Mean Jane for patient emergencies, but that’s just not who I am.

_____

When Mr. Chambers shows up fifteen minutes later, I have to spend another ten minutes convincing him to go to the emergency room. I check in the computer a few hours later to see how he’s doing, and it turns out they found blood clots in his lungs. He might not have been thrilled about going to the ER, but we very well might have saved his life. I don’t get to save many lives outright in primary care, so it’s a good feeling.

After five, things get very quiet on Primary Care C. Barbara leaves at four-thirty on the dot, not a second later, and after that, I’m responsible for making my own check marks. Unsurprisingly, it doesn’t add that much to my workload .

At the county hospital where I did my residency, the hospital would have still been bustling at eight o’clock in the evening. But it’s not like that at the VA. Quitting time is four-thirty, and by four-forty, the VA is a ghost town. Even George the elevator guy has left for the day.

I can’t say I don’t feel the tiniest bit nervous as I ride down in the elevator. Ben once told me I should get a can of mace to carry in my purse. Although honestly, I don’t think I’m a mace kind of person. I can’t believe that if I were ever in a situation where I actually needed mace that I’d be able to use it properly. I’d probably accidentally squirt myself in the eyes with it.

Maybe I should get myself one of those really loud horns. You can’t screw up honking a horn.

As a compromise, I grab my car keys and I thread the pointed end between my forefinger and middle finger. I took a one-hour self-defense class once where they said that you could use your key as a weapon if you held it this way, and then you stab your attacker in the belly and yell, “No!” The yelling of “no” seemed to be essential to the defense strategy.

I look down at my key. I can’t actually imagine stabbing someone. But it makes me feel better.

As expected, the lobby of the VA hospital is empty. Completely desolate. I walk across the lobby as quickly as I can, but before I get to the doors, I hear a voice:

“Dr. McGill? ”

It’s Sam Powell. The guy who thought he got herpes from a newspaper.

“Hi,” I say. I tighten my grip on the key in my hand.

“Listen,” he says. “I was thinking about it, and I think I do want to be tested after all. So can you give me that kit?”

“Um.” I don’t know whether I’m more scared or irritated. Irritated, I think. “I don’t have it with me, Mr. Powell. Can you come back tomorrow?” When there are more witnesses.

He frowns at me. “I’d really like to have it now.”

“I’m sorry,” I say. “I can’t give it to you now.”

Mr. Powell’s eyes darken and my pulse quickens. I think about the key in my hand. What was I thinking ? This key is completely useless . I can’t stab someone with this! If he decides to attack me, that’s it. I’m attacked.

Maybe I can surreptitiously call 911.

“Dr. McGill!”

I hear the second voice coming from across the lobby. I turn my head and before anything else, I see the green scrubs. I know who this is. I know who’s coming to save me. Again.

“Dr. Reilly,” I manage.

He jogs across the lobby, never taking his eyes off my patient. He gets it. He steps right between me and Mr. Powell, standing close enough to be intimidating. Ryan has at least two or three inches on Mr. Powell, as well as at least twenty pounds of muscle.

“Is there anything I can do for you?” Ryan asks Mr. Powell in a hard voice.

“I…” Mr. Powell glances at me, then back at Ryan. “No. I was just leaving.”

“Great.” Ryan nods in the direction of the door. “Have a good evening.”

Ryan doesn’t leave my side as we watch Mr. Powell exit the building. I look down at my hands, which are shaking. Ryan shakes his head as Mr. Powell’s hunched figure disappears into the distance.

“Don’t you have some mace?” he asks me. “You’re really lucky I was here.”

“He wasn’t really going to attack me,” I say confidently. I want that to be the truth. I don’t want to think about what might have happened if Ryan weren’t here.

He shrugs. “Yeah, well… I’m not letting you go out there by yourself. I’ll walk you to your car.”

I look at the short sleeves of his green scrub top. “You’ll be freezing.”

“It’s not that far,” he says. “I’ll be okay.”

He’s so good to me. He’s always been good to me. He looked out for me through three years of residency—I’m not sure if I would have made it through without him. I’d probably have quit and be doing… I don’t know, ps ychiatry or physical medicine right now. He’s stood up to patients for me before. Somehow when I’ve needed him, he’s always been there. And I don’t think it’s a coincidence that he showed up right now, when I need him the most.

If something had happened to me tonight, would Ben have even cared ?

“Jane…” His dark blond eyebrows knit together. “Why are you crying?”

“I…” I wipe my eyes with the back of my hand. “I think my marriage might be over.”

His blue eyes widen. After a beat, he grabs my arm and gently pulls me toward the elevators. He hits the button for up.

“Where are we going?” I ask.

He shakes his head. “You really want to talk about this in the lobby?”

I try to get my tears under control in the elevator, but it’s hard. I know I look like a mess when I’m crying. My nose gets all red, my face gets splotchy, and my eyes become bloodshot. Despite everything, I still care what I look like around Ryan.

We end up at the end of a long hallway on the eighth floor, in front of a door with a sign that reads, “Ryan Reilly, MD. Associate Chairman of Vascular Surgery.” And his office is befitting of a guy who is the associate chairman of vascular surgery. Mine barely has room for my desk and a couple of chairs, but his is spacious enough to include a luxurious leather sofa that’s probably nicer than anything in my house.

“Don’t get too jealous,” Ryan says. “The sofa is from my office at the private practice where I worked before this.”

I sink into it, trying to smile through my tears. “It’s really comfortable.”

“I know,” he says. “That’s why I made them buy it for me.”

I wipe my face again. I look down at the gold band on my fourth finger. Sometimes during the day, I look at it to remind myself of Ben. Or at least, I used to. I don’t think I’ve done that in a long time.

Maybe Ben is right. Maybe our marriage has become nothing more than a division of labor.

“Jane,” Ryan says softly. I turn to look at him, at the features I got to know so well during what I used to think were the hardest years of my life. “I just want you to know that… if your husband doesn’t appreciate how great you are, then to hell with that guy. To hell with Pip. Because you’re… I mean, if I hadn’t been such an idiot…”

I feel all the little hairs on my arms stand at attention. “What are you saying?”

“I don’t know what I’m saying.” He shakes his head. “But you… you’re the only woman I’ve ever met who made me want to take that damned test and figure out on ce and for all if I could have a real life. And I wish that…”

He looks like he has more to say, but instead of saying it, he leans forward and kisses me.

For a decade, ever since that night we ate Peking duck together, the only man that I have kissed has been Ben. But kissing Ryan is so familiar—it’s like riding a bike. If you’ve done it before, doing it again is so easy. Too easy.

But the problem is that I can’t stop. And neither can he.

It makes me feel better. All the anger and hurt I felt from the words my husband said to me last night drain out of my body as Ryan gently pushes me down on the leather sofa and continues to kiss me. Christ, he’s still a really good kisser. Then he pulls his scrub top over his head and I nearly gasp at the sight of his chest—wow, he certainly hasn’t let himself go over the last decade.

Against my will, I’m reminded of the first time Ben and I had sex. We had been dating for a couple of months, but he hadn’t been pushy with me like some men were. But that night, we had just been to a wedding of one of Ben’s friends where he was one of the groomsmen. There was a reason that Ryan refused to ever take me to a wedding when we were dating—“it gives you women ideas .”

Well, maybe that wedding did give me ideas. Or maybe it was because Ben looked so handsome in his tuxedo. I remember catching his eye during the ceremony, and when he smiled at me, I melted. I couldn’t keep my hands off him during the entire taxi ride home—I could see the driver giving us dirty looks in the rearview mirror.

When he was following me up to my apartment, I murmured in his ear, “You got a condom in your wallet?” Ben’s brown eyes widened and he flashed me a grin like I’d told him he’d won the lottery. The answer was yes, by the way.

And in the privacy of my bedroom, he pulled off his black jacket, his tie, and then he unbuttoned his pressed white shirt. Except when Ben took off his shirt, his ears turned red and he said, “Sorry.” Lord knows what he was apologizing for. Did he think I was expecting The Rock’s chest to materialize under his tuxedo? Ben’s chest was slim, hairy but not too hairy, and perfect. And when I pulled off my own shirt, he made me feel like I was perfect too.

I remember the way Ben kissed me, his fingers trembling with eagerness. He couldn’t figure out the clasp on the back of my bra. He worked on it for over a minute, finally pausing between kisses to enlist both his hands and all his concentrations to get it open. I teased him over that one for months, until one day he made me sit in his embrace and allow him to practice until he could undo the clasp one-handed .

Sex with other men before him was usually good and sometimes great, but it was never quite like it was with Ben. Maybe it was his eagerness or excitement, but there was something that just felt right about it. I felt like a piece of bread with peanut butter on it that had just found a matching piece of bread coated with jelly.

Ben would like that analogy.

We couldn’t keep our hands off each other for most of our courtship, and even after we got married. When we finally decided to go off birth control, I got pregnant instantly. When I first told him, he grinned and said, “Well, of course you’re knocked up. We had sex like a million times last month.”

When I was one week overdue with Leah, and we had tried all the long walks, spicy foods, and evening primrose oil that I could stand, Ben insisted on taking me to bed despite my protests that I felt like a whale—I had gained forty pounds in pregnancy, my stomach was the size of a beach ball, and every inch of me was swollen and disgusting. But Ben kissed me everywhere and acted like I was just as sexy as I ever was. And the next morning, I started having regular contractions.

I was in labor with Leah for over twenty-four hours. Ben never left my side once during that entire time. In retrospect, I’m not sure when he went to the bathroom, because I cannot recall one second when he wasn’t holding my hand. The nurse had to force him to eat some food from their kitchen, because Ben insisted, “If she can’t eat, I’m not eating.”

I didn’t cry the first time I held Leah. But I cried the first time that I saw Ben hold her. He sat on a chair beside me, awkwardly holding that tiny little bundle we made in his arms, and all I could think was, “I’m so glad I picked him.” I was so glad I picked this man to be my husband, to be the father of my daughter, to be my partner for the rest of my life.

Oh God, Ben.

I shove against Ryan—harder than I’d intended. He jerks away from me, blinking his eyes in surprise. He tries to lean in again, but I hold him at arm’s length.

“You’ve got to be kidding me, Jane,” he grunts.

“I’m sorry,” I murmur. “But I… I can’t do this.”

“Sure you can.” He leans in again to kiss me, and this time I roll out from under him, clutching my shirt to hold it closed. He sighs loudly and drops his head against the couch. “Christ, I need a cold shower.”

“I’m sorry,” I say again. “But I just… I mean, Ben’s my husband, and I can’t…”

“Is that so?” Ryan rolls his eyes but he doesn’t look as angry as he has a right to be. The thing is, I love Ryan. Or at least, I used to love him, and I thought that I was capable of loving him again. Except as we were kissing, it was all too obvious to me that Ryan Reilly is not my soulmate. He’s a guy that I enjoyed hooking up with years ago but he’s not the love of my life. The love of my life is at home right now, with the child we made together. And even though he walked out on me last night, I’ve got to try to make it work with him. Whatever it takes, I’m going to do it. Ben is the one I’m meant to be with.

I hear a buzz coming from my purse. A text message.

“I should see what that is,” I murmur.

Ryan nods. I feel his eyes on me as I pull out my phone from my purse. I discover that I have three text messages from Ben that I missed. The first is from two hours ago and says: Leah used the princess potty! She’s really proud of herself.

The second, from an hour ago, says: Can we talk when you get home?

The third says: I’m really sorry. Please come home, Jane.

I swallow hard as I stare down at the words on my phone. Ben’s sorry.

“Is the text from Pip?” Ryan asks.

I nod. “I’m sorry,” I say for what feels like the millionth time.

He pushes himself up into a sitting position on the couch. “Don’t be sorry. I knew you wouldn’t really cheat on your husband. You’re too… moral.”

My cheeks grow warm. “Well, I did let you kiss me.”

“Yeah, I’m shocked I got that far.” He shrugs. “I’m too late. It’s okay—I get it. ”

“Maybe if you had gotten tested back in residency, it would have been different.

He manages a crooked smile. “Yeah. Maybe.”

I button up the two buttons on my shirt that Ryan managed to undo, grateful I didn’t let him get any further than that. I regret even those two buttons. I feel the burn of Ryan’s stubble on my chin, and I’m overcome with guilt that I actually allowed another man to kiss me. It’s Ben’s fault—how could he have said all those things to me last night?

Ryan gets up from the sofa and stretches in a way that emphasizes that the muscles in his arms and chest are just as tight as they were ten years ago. He’s really managed to keep in good shape. I genuinely don’t know how he does it. He’s even sexier than he was back then.

He throws his scrub top back on, which helps me to think straight again. The tie on his scrub pants has come loose, and I watch him cinch the waistband. And just as he’s tying the blue drawstring, I see it happen:

His right hand jerks away.

My breath catches in my throat. I didn’t just imagine that. His arm moved in a way I’d never seen before, at least not in a normal person. Maybe if this were someone else, I would have been able to ignore it. But this is Ryan . Whose father died of a degenerative disease that causes jerky, involuntary movements of the arms and legs.

“What was that?” I ask .

He lifts his blue eyes to meet mine. I had expected him to look as freaked out as I feel, but he doesn’t. And that’s what really freaks me out.

“What was what?” he says.

“The way your arm moved,” I say.

He’s quiet for a moment. Finally, he says, “I don’t know. Nothing.”

“Ryan…” I look into his eyes and all I can see is sadness. And that’s when I know for sure. “How long have you been having symptoms?”

He sighs and drops down onto the sofa. He leans his head back, staring up at the ceiling. “A year.”

“A year ?”

Oh my God, he’s known about this for a year. An entire year. So that means…

No wonder he came to work at the VA. He probably couldn’t keep up the pace of private practice. I can’t believe I thought he came here because of me . I’m such an idiot.

“Have you gotten an official diagnosis?” I ask him.

He nods slowly. “Yeah. After the symptoms started, I knew I had to be tested. And… big surprise. I’ve got Huntington’s disease. Just like my dad and my brother.”

I cover my mouth with my hand. I can’t believe this. Despite everything, Ryan always seemed indestructible. I can’t imagine him degenerating the way his father did. But he will. It’s in his genes. Stupid genes .

As I watch him run a shaky hand through his hair, something occurs to me: “Are you safe to operate like that?”

Ryan narrows his eyes at me. “ Yes . Christ, Jane, you think I would operate if I felt that it wasn’t safe?”

I don’t say anything. I know Ryan loves to operate—it’s what he loves the most, what he lives for. I don’t know if he’d give it up so easily.

“I wouldn’t,” he says firmly. “I only get the symptoms when I’m really tired or stressed. And I take a medication to block them. But I couldn’t handle the private practice. It was too many surgeries. I had to cut back.”

It must kill him that he’s in his mid-forties and should be in the prime of his career, but instead, he’s cutting back. “And what about when it gets worse?”

“That’s what’s great about the VA,” he says. “I can still work here doing administrative and research stuff even if I can’t operate. And when I can’t do that anymore…”

I raise my eyebrows. “What?”

“Well.” He looks down at his hands, which are perfectly steady now. “I’ve got a gun locked away in my desk drawer at home.”

I try my best to mask how horrified I feel. He’s always told me, from the day I found out about him, that he refused to live like his father did. If it ever came down to the point where he needed nursing care, he’d rather end it.

But that’s a long time away.

We stare at each other for a minute, but it’s not the same way as before this revelation. It’s not the same as that day when he rescued me in the parking lot by shoveling out my car. And then it occurs to me that in five years, he probably won’t be able to shovel off my car anymore. The thought of it makes me almost start crying again.

“Come on,” he says. “I’ll walk you to your car.”

“You don’t have to…”

“Please.” He holds up his hand. “Let me protect you while I still can.”

He takes his jacket because it really is very cold outside. I don’t see any other jerky movements on his part, but I know that they’re there, under the surface. He’s just going to get worse. Not if, but when.

My boots are still useless. My feet get absolutely soaked during the trek out to my car. As soon as I get home, I’ll have to peel off my socks. And Ben will be waiting for me. God, I don’t even want to think about what’s going to happen when I see him.

When we get to my car, Ryan nods at me. He doesn’t say a cheesy goodbye, and for that, I’m glad. It’s not his style. As for me, I didn’t make a speech when I dumped him for Ben the first time around, and I’m not going to make one now.