Tony Scott, MD

ALONG CAME COVID

LOVE AND LOSS IN THE 2020 PANDEMIC

Chapter 1

Faith Pernitelli, just weeks out of medical school, stood with the team of physician trainees at her first morning rounds. On the one hand intimidated by the upcoming expectations and responsibilities in a strange environment, and on the other hand proud to be a physician ready to step up to a new level of patient care. She looked around at her new colleagues, only known by brief introductions at orientation.

“I’m Faith Pernitelli,” she said, prompted by her superior for self-introduction. “I am from Lubbock, Texas, where I went to college and medical school — and to kindergarten through twelfth grade.”

“Thank you, Faith,” Ann said. “It wasn’t hard to hear the Texan part in your accent.” Ann McCauley was a second-year fellow, having completed the four-year residency in obstetrics and gynecology, the one Faith was now starting, and in her sixth year of training after medical school. “What brought you to Albuquerque?”

“I matched here,” Faith said. “I didn’t want to stay in Lubbock. It was time for a change.”

“Welcome. Here are the duties expected of a first-year resident,” she said, handing Faith a sheet. “It’s not a complete list. Everybody is expected to do whatever needs done, when it needs done. You can call anyone on the rest of your team if you need help, and, in return, you can expect to get called to help. On the back of the sheet are some important telephone numbers which we all have memorized, and you will too, in short order.”

Faith grinned, looking at the sheet which was well organized. An explicit assignment and a place on the team slowed her thundering heart. “I can handle that.”

Ann looked to some other faces. “What about you?”

“I’m Josh Menkowicz from Oklahoma. I like fetuses, births, and pregnancy. I went to college and medical school in Oklahoma and needed a change of scenery, like her.”

Ann gave Josh another copy of the informal job description sheet she had just handed Faith. “Welcome.” Without a breath, another tattered scrap appeared from her pocket. “Today, we have a cesarean section on a patient with a large baby and there is a patient in labor. We have an asthmatic spending her second day here getting her medications adjusted. There are some patients who delivered yesterday who need to be discharged, given appointments, and have prescriptions written.”

“Which of those do I participate in?” Faith asked.

“Faith, why don’t you help with discharges and post-partum rounds, and Josh, why don’t you go see the cesarean patient, make sure admission paperwork is done, and then help me with the cesarean.”

The group broke out in conversation as they scattered to their duties.

Josh and Faith stood scanning their duty sheets as Ann approached. “I’m Ann McCauley. The rest of the team and I will sort of herd you into your duties. Normally, one of you presents the patients, and then one of the more senior residents presents the complicated patients, like our asthmatic.”

“I think we can jump right in,” Faith said. “I didn’t have trouble assimilating on any of my senior medical school rotations, even the short ones. This little cheat sheet you gave us will really help.”

“Yeah, we’re on it,” Josh agreed. “We won’t disappoint you, Ann.”

Faith followed the cheat sheet and the advice from several others as they visited patients on the post-partum unit. “Hi, I’m Dr Faith,” she said to a woman standing at the bedside attempting to pull clothing on to a baby flailing hands and feet. She had learned in medical school that patients handled “Faith” well and “Pernitelli” poorly. “I understand you are planning to go home today.”

“Yes,” she answered. “I am excited about that.”

“Do we call you Angela?”

“Or Angie.”

“Did you already get your rubella vaccine?”

“Yes, just a few minutes ago.”

“What is your plan for contraception?”

“I always took the pill, and it worked out well for me.”

Faith went through several other issues, including vitamins, her follow-up appointment, about bathing and showering, and where to call for help with breast feeding. “Do you have any questions?”

Angie studied Faith’s face, then returned to her baby. “Why do I feel so down? This morning I cried because I dropped a clean diaper on the floor. Is that normal?”

“Yes, completely. Pregnancy makes huge body and brain changes, then the birth comes along and brings it all to a screeching halt. You might have some other things that happen, too, like having trouble sleeping, weird dreams, or forgetfulness. If there is anything bothersome that sticks around, you should call us.”

“Thank you. Where do I call?”

A glossy booklet lay on the foot of the bed. Faith opened it and circled the number inside the front cover. “Don’t hesitate. Even if it’s in the middle of the night or on a weekend, someone can talk to you.”

“Thanks.” She picked up her baby and handed him to Faith.

“Who is this good-looking one?”

Faith mirrored the wide grin on the patient’s face. “Joseph Oliver,” Angie said.

“He sure is good looking,” Faith said. “You get to go home today, Joe. I’ll bet you have lots of visitors in the next few days.”

Through the persistent grin, Angie said, “He has no idea. Both me and my husband are from big families. Among my cousins, two other babies were born already this year, and there will be one more.”

“Aww.” Faith looked back at the baby in her arms. “You’ll have to learn a lot of names, Joe. I hope you can handle it.” Joe slept on. “You’ll have plenty of cousins to play with. Here you go, Joe. Your mom will take you home.” After handing off the baby, Faith said, “Well, good luck. Call us if you need us. See you in six weeks.”

“Will I get to see you?” she asked.

“Yes, I made the appointment for me.”

“OK. See you then.”

Faith left the room, striding down the hall to the charting station where Josh was seated clicking away at a computer. “What are you doing here?”

“The cesarean was delayed, so I came to enter some more information on the patient.”

“I’m glad the computer prompts us,” Faith said, “otherwise, I’d be lost.”

“In a week, we’ll be sailing along, I bet.”

“I hope it doesn’t even take that long.”

He looked up from his work, “Do you want to get something to eat?”

“Yes, I skipped breakfast. I was too nervous to eat, but now I’m starving.”

In the cafeteria several floors below, the main hot meal line had closed until lunch. There was a bar with fruit, muffins, donuts, and coffee. “I need coffee,” Josh said.

They didn’t sit but headed back upstairs. She said, “I want to learn a lot and become an excellent obstetrician. I hope Ann and the others don’t mind machine-gun questions. Some of the residents and attendings were put off by that on some of my medical school rotations, but I didn’t care. If I wanted to know something, I just asked.”

“I was never that brave,” he said. “I asked questions, but I can’t interrupt a discussion for one.”

“I don’t have any trouble. I don’t need to be the best liked by my mentors or the best friend of my peers.”

“I get that,” he said, pulling his phone from his pocket to answer it. “The cesarean is ready to go. I’ll see you later.”

She went on to see more patients, one of whom talked to her about when to go back to work. “I think that is more up to you than to anything medical,” Faith said. “There really isn’t any way for you to injure yourself, so it has to do with childcare, your personal preference, and your energy level. Remember, you are getting this advice from someone who’s never had a baby.”

“But you seem to have a brain, unlike some of our doctors and nurses,” she said from the reclined position on her bed.

“This is your third baby,” Faith said. “Your life is going to be really hectic, if it wasn’t before.”

“It was. I even worked part time. I don’t know if I can do that now. Childcare is expensive, and I don’t know if my husband is up to three kids for a whole weekend like before.”

“There are so many adjustments. Some of them will disturb you, but don’t worry about that. How is your family?”

“I have a good husband, a sister, and a sister-in-law who have been helping me a lot. My mom gives me good advice, but she works, so she’s been limited help. I’ll be able to manage.” Faith heard the coming challenge in her voice.

“Good,” Faith said. “Is there anything I can do for you?”

“No,” she smiled. “I didn’t plan this one, so I’ll just have to work it out.”

“You’ll do fine.” Faith reviewed the call center number in the same glossy folder she had shown Angie. “Well, good luck. Call us if you need us.”

At the charting station, Faith wondered if her advice was correct, if it was helpful, and if there were elements she missed. She had completed all the pieces Ann had listed on the cheat sheet, but she wondered if the sheet was the cake but not the icing.

“Ann,” Faith said when Ann whipped into the charting station, “I don’t know if I’m getting it all done. The patients ask me for advice, and sometimes I don’t know what to say to help them.”

“First, being upbeat and positive is as useful as what you tell them,” Ann said. “Only experience and follow-up will answer the rest. There are patients who need to be pushed, and some who need to be slowed down. It will take time for you to get a routine and into a comfort zone that works for you and your patients.”

“Thanks, Ann,” Faith said. “I hope I get there quickly.”

“I know you will,” Ann said, “because you want to.”

“Really?”

“Yes. Don’t worry about it.” Ann whipped away.

Faith dialed her phone. “Hi Dr Faith. How’s it going?” Faith’s sister Natalie was always a comfort.

“I think well. I saw some patients on my own, and I think I did what I’m supposed to. Our leader, named Ann, is really helpful. She gave us a cheat sheet of our duties, which is fabulous. I think it will be fun. I like the patients.”

“That all sounds good. Who is us?” Natalie was young but unusually perceptive.

“Me and Josh, the other first-year resident on this service. He is lucky because he is doing a cesarean now and has a delivery later today.”

“That’s exciting. How come you don’t sound like it is exciting?”

“It is exciting,” Faith said, “but it’s also scary. I’m now in the thick of things. As a medical student you’re more of an observer. This is a huge step.”

“That’s what you always said it would be.”

“Yeah. I don’t know if I realized how big a step.”

“Oh, Faith, sometimes you’re a weenie. I’ll bet in two weeks you’ll be scurrying around not thinking about it at all.”

“I hope.”

“Mom says you’re having trouble with Brian again?”

“Again?” Faith said. “Not really. Just the same. I don’t know where this is going.”

“He’s not a husband, Faith. What is he? Are you going to do anything about it?”

“Not right now. I have too much on my plate. I have to get into this residency and get my feet on the ground.”

“Don’t you have him as your supervising attending at work?”

“We will have,” Faith said. “We had our director today, Emily Beacham. She is a really good instructor. I can’t imagine Brian being like that — or even wanting to be.”

“What has to happen before you actually take some action, Faith? Don’t you agree things are not good as they should be?”

“Yes. But I can’t tackle that until work settles into a routine.”

“Whatever.” Natalie was pushy and honest but didn’t overkill an argument.

“I’ll talk to you later,” Faith said.

“Sure. I love you.”

“I love you too.”

Faith sat in silence for a few minutes trying to put the whole thing together. Brian was being a pain in the neck, and now he had accepted a position which made him her supervisor at times, never the case in Lubbock. Because she had maneuvered her senior year Ob-Gyn rotation while he was out on rotation in his fellowship, she had avoided any direct interaction. She was not looking forward to this new arrangement. How would she be able to interact and question him the way she did her other mentors?

Home wasn’t working, but it wasn’t at a flash point either. She would be able to tackle the Brian problem when work had settled down, after she had grasped her responsibilities, and after she meshed with her co-workers. She also had to settle into her new apartment, unpack boxes, and find the laundry room. Her Brian problem would have to wait.

Chapter 2

Haley Denton, a third-year resident, opened morning rounds. “We have been reading about a new coronavirus which has been causing severe respiratory failure in China. There is now a report of a patient in the state of Washington who has this disease. I couldn’t find any more information. The first identification of it was late last year, so we are calling it COVID-19.”

At each of morning rounds, a faculty member, called an attending, was present, whose duty it was to be instructive, directive, and supportive. Brian Yankton, today’s mentor, asked, “There are dozens of human coronaviruses, most of which are innocuous respiratory illnesses that cause few if any hospitalizations or deaths. Do we think this virus is any different?”

“Yes,” Haley said. “According to the article I read, this one is on the order of SARS and MERS. MERS was well contained in the middle east, SARS has disappeared, but both were deadly.”

Faith said, “It’s already inside the United States?”

“In Washington state.”

“Was there was ever a case of SARS or MERS in the United States?” Faith asked.

“There were SARS cases in the United States, but there were no cases of MERS.”

“OK,” Brian said. “Let’s move on to the patients and get rounds finished.”

“Wait,” Haley said. “The whole point of rounds is to explore issues like this and expand our knowledge, is it not?”

“Yes, but we did that,” his inflection impolite. “It’s time to move on.”

Faith opened a folded sheet of paper. “We have two patients in labor, both of whom should deliver today. There is another who just arrived who we don’t think is in labor and can go home.” She made no eye contact with Brian.

“I need you to call and tell me about her before you discharge her,” Brian said. “I want to hear about each and every patient.”

“We have a patient with type one diabetes who has been here three days, recovered from diabetic ketoacidosis, and is ready to go home.” Ann stopped.

“Is she on a pump?” Brian asked.

“No. She does her own administration.”

“Can’t she get a pump?”

“No,” Ann said. “She can’t afford one. We do the best we can with those who have monetary constraints.”

“OK,” Brian said. “Thanks everybody.”

Ann approached Brian. “Do you have some idea about how to manage economically disadvantaged patients like this that you didn’t discuss?”

“No,” Brian said. “Insulin pumps and continuous glucose monitoring are what we should be doing. If the patient doesn’t comply, I am not sure why we even bother with her.”

“Sir, we have to take care of them the best we can. Otherwise, they show up in labor with dead babies, ketoacidosis, or worse.”

“That’s not our problem. What happens to them if they don’t comply with what is usual and standard care we are not responsible for. Besides, she already showed up in ketoacidosis.”

“I can’t believe you think like that,” Ann said. “Don’t we owe them the best we can do under the circumstances? We should prevent every catastrophe we can.”

“Look, Ann, I’m the attending here. We do this my way. I don’t care what happens to patients who choose not to accept our advice and recommendations. That’s on them, not on us.”

“Whatever.”

“And another thing,” Brian said. “I don’t appreciate you extending rounds after I have left, like you have been doing. You are not empowered to make management decisions in my absence or without my approval.”

“Those rounds don’t make management decisions,” she said. “They are for teaching. We discuss the issues brought up in rounds and I facilitate discussions of the options, including ones we don’t practice here. There are well accepted practices that people use in other places, and our residents need to hear about them, discuss them, and understand why we do what we do the way we do.”

“They can get that information on their own. Let them do it.”

“No. They need to hear the discussions. On oral examinations, the proctors are going to expect candidates to discuss the pros and cons of several management strategies and the reason the candidate prefers his or her selection.”

“They can get that at meetings and on pod-casts.”

“Whatever.”

“Why do you always blow me off?” He was annoyed by Ann, both in being challenged on treatment choices and in her insistence on being instructive. “You always disagree with me.”

“A lot of times I’m not disagreeing. I am trying to get you to discuss other options. Our duty is not only to our patients, but also to our trainees. We need to model instructive as well as clinical behavior. We need to model logical thinking based on current unbiased information.”

“I do that well enough, I think,” Brian said. “There’s no end to what we could do, but a practical limitation on what we should do.”

“Whatever.” She walked away.

Chapter 3

Faith was ushered into an examination room in the office building, expecting to get her IUD replaced. She had made a visit a week earlier where a good exam, cultures, and a pap smear were performed. She was here for test results and to have her current IUD removed and a new one inserted. They only last five years, and she was a little past that.

Dr Michelle Scroggins came through the door. Not knowing any of the faculty more intimately than putting names with faces, she had selected the chairman of the Ob-Gyn department somewhat arbitrarily.

“Hello, Faith,” Michelle said as she entered the room. “How is life treating you?”

“Fine,” Faith said. “I am getting into the residency pretty well, I like the patients, and I like our attendings.”

“I have heard that you are doing well. Emily says you are reading, assimilating, and asking a lot of questions.”

“I want to be an excellent obstetrician. I want to pack everything I can into my brain.”

“That’s a good approach,” Dr Scroggins said. “We have some tests to discuss.”

“Yes. I’m ready.”

“Your pap smear is normal, and your papillomavirus test was negative, so you don’t need another pap smear for three years.”

“That’s good news.”

“I’m afraid there’s bad news to go with it.”

“Oh?”

“Yes,” Michelle said, making eye contact. “You have the sexually transmitted disease chlamydia.”

“What?"

“You have chlamydia. I can give you a prescription for four capsules of azithromycin which you should take all at one time. There will be enough medicine for your partner. You should treat each other on the same day, then you don’t have to worry about reinfection or cure.”

Faith was stunned. She could feel tears well up in her eyes, part injury, part anger, part embarrassment. “I can’t believe this,” she blubbered. “I’m sorry. I’ll get it together. Do we need to test Brian?”

“No. Unless you have other contacts, there is no question he has it. Do you have another contact that I should include in your prescription?"

“No. We have been together seven years or so, and I have not had contact with anyone else.”

Michelle looked at her computer and typed a few characters and stroked the touchpad. “We should wait a week or two to change out your IUD, so we don’t infect your tubes. Make sure Brian gets treated.”

“I will. I’ll make another appointment. Or maybe you should remove this one now and I come later for a new one.”

“I can do that.”

The exam was brief, and against Faith’s expectation, removal was a breeze. She looked at herself in the mirror as she was dressing, wondering what had become of her marriage. She thought of Natalie’s opinion, about how disagreeable he had become, and of her father’s unenthusiastic attitude toward Brian. Listening to Brian’s interaction with Haley and Ann, she reaffirmed that his irritability was not only toward her. But it was still a problem.

A whirlwind of thoughts pummeled her brain as she drove home, changing her over from hurt and disbelief to anger. She went to the kitchen to fix dinner, usually a relaxing activity she relished. She added a glass of wine to the activity.

Half an hour later, Brian came through the door, dropped his book bag, and walked through to the bathroom.

Faith called out, “Dinner’s ready.”

He didn’t answer. She plated dinner and put the plates on the table. It was the good night, the one between the night-after-call and the night-on-call, and she wanted to go for a run. She sat at the table, hesitated, and started to eat.

Brian later sauntered to the table, sat, and sarcastically said, “Thanks for waiting.”

“I wanted to eat my food while it was hot,” she said. “I told you it was ready. I haven’t seen you for days. What do you do all day?”

“Today I was in the office. Yesterday I was in the office in the morning, and I read in the afternoon.”

“Where were you?”

“In the library.”

“Across the street?”

“The only one.”

“Did you remember I had my gynecology appointment today? I was supposed to get my IUD replaced.”

“I forgot.”

“Well, guess what? I can’t have it replaced yet because I have chlamydia!”

“What?”

“I have chlamydia. And you now need to tell me where you got it.”

“I don’t have anything wrong with me. Where did you get chlamydia?”

“Only from you, Brian boy.”

“Well, I don’t have it.”

“Jeez! How many times have you heard patients say their men denied they had it? Now get it right.”

“Well, I don’t have it.”

“Yes, you do.” She handed him a little bottle of pills. “Here is your medicine. I want to watch you take it. Then I want you to explain how you got it. Are you back with that woman you met in Dallas? Or is this a new one?”

“I’m not with anyone. I haven’t—”

“Stop! Now take your medicine.”

“If I don’t?”

“Then you’re on the couch until further notice — that is, if I let you stay here.”

“Are you threatening me?”

“Yes.”

He growled and stood. He grabbed the bottle of pills, hiked them in his mouth, and swallowed them with a swig of the iced tea on the table. “There.”

“Now tell me what’s going to happen. It won’t work if you just go out and get it back from her.”

“I’m telling you. I broke it off.”

“That’s what you said before. Why do I not believe you now?”

“It’s the truth,” he said.

“Where were you yesterday afternoon?”

“In the library.”

“Can you prove that?”

“How could I?”

“Show me your computer login record. It would show where you logged in from.”

“I didn’t log in. I just went to read in a quiet place.”

“Why don’t I believe you?”

“There isn’t anything else to say.”

She finished a few bites on her plate. “I’m going for a run.” In a few minutes, she emerged from the bedroom in running clothes but stopped dead at the dinner table.

“Aren’t you going to clean up dinner?”

“I wasn’t planning on it.”

“I made dinner. I even cleaned up all the pots and utensils. All you have to do is load the dishwasher.”

He isn’t a husband. What is he? Natalie’s words echoed.

“They’d better be cleaned up when I get back,” she said, opening the door and placing ear buds.

“Good-bye,” he said.

The run was rejuvenating, uplifting, and quieting. She enjoyed the fresh air, the pleasant temperature, and the beauty of the sunset. But as she rounded the last corner toward home, the ache in her soul produced mascara-laced tears.

She opened the door and stepped in, wet hair, damp clothes, and still breathing heavily. “Why didn’t you clean up dinner?”

“I’ll do it later.”

Her anger transformed into clanking dishes, rattling silverware, and banging cupboards. When she headed for a shower, the dishwasher hissed. There was no perceptible response from Brian.

Emerging from the shower in a bath robe and with a towel on her head, she turned on the television. “I need some noise to study,” she said. “It’s too quiet in here.”

Body language, a sigh, and a glare showed his displeasure, but the usual argument didn’t ensue.

“You know, Brian, I think I want you to move out. Just get a few of your things and get out of here for a while. I have to reconcile this in my brain.”

“Where am I supposed to go?”

“I don’t care. Get a hotel room for a few days. Then we can talk about it again.”

“This is my apartment. My name is on the lease. If you are so adamant about separating, you’re the one who should leave.”

“No. You’re the one who screwed this up — literally. You should bear the consequences. My name’s on the lease too.”

“OK. Whatever.” He went about packing a few things in a roller bag, took his laptop and left, slamming the door behind him.

“God, Natalie,” Faith said when Nat answered the phone. “Guess what! He gave me an STD.”

“Ha,” she spurted in return. “See, you should have kicked him out.”

“Nat, I still would have chlamydia.”

“Well. What a rat! You deserve better than this. Can I tell mom?”

Faith’s heart stopped. “Tell mom?” She had to process for a moment. There were no secrets in the family, but Natalie was a reliable confidant when necessary. Maybe it wasn’t necessary. “Yes, I guess so. I kicked him out.”

“Now,” Natalie said, “you need to resist taking him back. This should be it. Quit being the softie.”

Faith couldn’t process fast enough to respond before Natalie moved the conversation along. “You deserve better than this. You need to reset your life.”

“How’s mom?” Faith’s typical change-of-subject.

“Good. She has gotten control of her diabetes and has a new doctor she likes. Last night she went to a group meeting where she met other people with diabetes and learned new tricks. She sounded encouraged.”

“That’s good,” Faith said. “She was bummed out about the diagnosis. I hope she gets a grip of it.”

“She will.”

“I’ll talk to you later, Natalie. I love you.”

“I love you. Get rid of Brian!”

Chapter 4

Josh Menkowicz finished his computer work at the charting station in Labor and Delivery, looking forward to his call night and hoping to deliver several babies. Maybe he would get to participate in another cesarean section. Filling out his delivery log had been encouraging, building up pages of experience. After sorting and entering pieces of information into the computer, he crumpled a piece of paper and threw it across the room where it went directly into the trash can.

“Three-pointer!” Faith said, entering the charting area. “Good shot.” She went to the trash can, picked out the crumpled ball of paper, and handed it back to Josh. With a mischievous smirk, she sank into a chair, “I want to see it again.”

“There’s no way. That was just a lucky shot.” He pitched the ball toward the can where it went in again, then stood and raised his arms to the thundering arena.

“I can’t believe it!” she said.

“I want hot food,” he said, standing. “I’m going to the cafeteria. Do you want to come with me?” Wishful thinking.

“Yes,” she replied. “Let me get my card.”

He was surprised. When not on call, he was always anxious to leave the building for the freedom of outdoors and home, presuming she would feel the same way. But choosing to eat in the hospital cafeteria?

She was in and out of the locker room in a flash. The elevator ride was spent ridiculing the three-point trash can shots.

By this time, they had been colleagues for several months, which necessitated close interaction on a work level. Man, she’s married! What a perfect face, what energy and drive, what a soft spirit, and what a sense of humor. She’s so pretty she’s a hazard.

Josh placed his tray on a small table in the middle of the dining room. She followed shortly from the condiment buffet.

“Did you choose to eat here in the cafeteria? I would have been out the door and long gone.”

“I’m tired. The food here isn’t wonderful, but it’s hot, it’s really cheap, and I don’t have to clean it up. Maybe I can get a run in before bed.”

“What about your husband? Is he not at home?”

“Not tonight,” she said. The expected further explanation didn’t come.

Josh said, “Where are your rings?”

“Jeez,” she said. “I left them in my locker when I scrubbed for the cesarean this afternoon. I forgot them. I try not to leave them in my locker because I’m afraid they could get stolen.”

“If I were you, I would leave them at home. Besides being stolen, they could wind up in the laundry, down a sink, or get damaged by our equipment. Been there, done that.”

“With a wedding ring?”

“No, but with a watch and an ID badge.”

“I don’t know what my husband would think.”

“I can’t believe that’s the reason. You seem way more independent than that.”

“If I don’t wear them,” she said, “men sometimes hit on me. It’s irritating when I am trying to get my work done.”

“Then get a cheap Walmart special and wear it. That way, if you lose it, you’re out ten bucks.” He pointed to his watch, “Four-dollar Walmart special.”

Doctors can eat a whole meal in five minutes. He said, “I have to get back to work.”

“I’m tired, so I’m going home.”

She joined him in the elevator. “I thought you were going home.”

“I want to get my rings out of my locker. It’s a good idea to leave them home.”

“I was thinking about Ann,” he said. “What do you think she’s doing here? Why do you think she came to Albuquerque?”

“What do you mean?”

“She’s a unique character, in my mind. She’s bright, perceptive, and has energy. I have wondered why she isn’t in some big, high-powered program.”

“I don’t know much, but I know two things. Her husband is in the urology program here, although I don’t even know who her husband is. She told me when I said I needed a change of scenery that she needed one too. Maybe for the same reason we are. I didn’t get accepted at Texas Southwestern in Dallas and I didn’t want to stay in Lubbock, so I’m here.”

Josh nodded. “Me too. Enough Oklahoma, already. I wanted Southern California, but that didn’t happen. Are you disappointed you didn’t get accepted in Dallas?”

“At first I was. But now, I like this a lot. This program is smaller and cozy, I love the people, and I love the patients.”

She ducked into locker room. He sat in the charting area so he could see her again when she came back out. “See you tomorrow.”

“Yeah, Josh. Bye.”

Chapter 5

“I’m not sure I’m completely comfortable with this arrangement,” she said.

Brian had been at Super 8 for a week. He had talked to her on the phone several times, but each time the conversation had been court and cold. “I promise, I broke it off. I won’t see her anymore. You can trust me.”

“Well,” she said, “you’d better make good on that promise. This is strike two. If you violate me again, you’re out for good. I can’t stand this anymore. I don’t know why you treat me this way.”

He returned to the bedroom unaware she was following him. “What’s that?”

“Laundry.”

“You didn’t do any laundry while you were gone?”

“No. Where was I supposed to do that?”

She rolled her eyes. “At the hotel. They all have laundry rooms.”

He didn’t answer. Except for underwear, laundry didn’t need to be done frequently since hospital scrubs were worn at work, and jeans and a shirt were worn for the short commute.

“Do your own laundry,” she said. “And if you don't mind, please take out the trash tonight. Tomorrow is trash day.”

“There’s no trash day. There’s a dumpster you put trash in whenever you want.”

“But they empty them on Tuesday and Friday. So please take out the trash tonight. Besides, the kitchen one is full.”

He watched her reposition her legs under her on the couch and focus on the computer. “Why can’t you accept an apology and give me another chance?” he said.

“What?” she said, “I didn’t hear an apology!”

“OK. I’m sorry. I won’t do it again, I promise. I’m so sorry.”

“Here’s your chance. A probationary chance. You’re on notice. Either we make this work this time or it is over. Over.”

What had attracted her to him in the first place? He had been a resident in Ob-Gyn at Texas Tech in Lubbock while she was a medical student, and had taken an interest in her. After that, she had fallen head over heels. After several years of dating and another of living together, there had been a traditional wedding. Sister Natalie had been excited, only eleven years old at the time, but her dad had been cold as ice. Both of his parents adored her. Now here he was on the brink of the end of the relationship. What was going to happen? How could this heal? Where would this be in a few months or a year? Something was stabbing her in the chest.

She tried reading again, but the stony atmosphere was stifling. Finally, she went for a run. The air wasn’t as soothing, the sunset not as beautiful, and the pain didn’t subside. When she got back, Brian was in bed. She showered and went to bed.

Chapter 6

Rounds finished in record time since Brian rarely digressed to discuss the science or art of obstetrics. With Brian gone, Ann kept the group together to cultivate educational discussion.

Haley brought up coronavirus again. “There have been several deaths in the United States from this virus. It appears to be a bigger threat than initially presumed, more like MERS and SARS than colds. Health officials in Washington state have found it spreads unusually easily, especially in the elderly in nursing homes.”

“Does this mean we might be impacted?” Josh asked.

“Maybe,” Haley said. “If the virus is already deep in communities, how would we be able to prevent it?”

“What treatments are available?” Ricky asked.

“None. There is some speculation about hydroxychloroquine and remdesivir, but they were not effective against MERS or SARS.”

“Do we think this is worse than influenza?” Ann asked.

“Yes. Preliminarily, it appears to spread rapidly, cause severe cases and deaths.”

“This doesn’t sound good,” Faith said. “That means we’re down to supportive care and isolation.”

Ricky said, “How do you isolate whole families? How do you isolate a college classroom or a fraternity?”

“Aggressively,” Haley said.

“I bet pregnant patients are more susceptible and more likely to become severely ill, like for influenza,” Ann said. “I agree with Faith. This is not good.”

“There will have to be good research, good brain work, and a lot of improvisation,” Haley added.

“Good brain work leaves you out,” Ricky quipped. “Remember, everybody, she’s redheaded.”

“Shut up Ricky,” Haley snapped. It was their trademark routine.

The discussion ended and the group dispersed to their responsibilities.

“Thanks, Ann,” Josh said. “We need coaching and remediation when we have Brian. You always get good discussions going like other attendings, especially the boss.”

“You’re welcome. It helps me too. Sometimes you guys ask questions I never thought of asking. Having to read and fill in the blanks is good for me.”

Faith said, “I agree Emily is especially good at it. The more the better.”

“The boss is quite knowledgeable,” Ann said. “I want to become like her.”

“I think you already are,” Josh said. “You have much the same style as Emily. You put out a question, wait for several different answers, and then tease apart the issues.”

“I have to get to work,” Ann said. “See you guys later.”

“Ann seems to have her heart in this job,” Josh said.

“We have to be more than doctors,” Faith said. “We need to be humans, too. I like it when patients tell me things about themselves that don’t impact my medical decision making directly. A few weeks ago, I discharged a patient who I saw in the office yesterday. Baby Joseph is looking around, making cooing sounds, and focused on my face directly when I spoke to him. You can tell he comes from a big family. Amazing.”

“Wouldn’t you want your doctor to be like that?”

“Oh, yes. The problem is time. It seems like I have to watch the clock, so I don’t get carried away.”

Josh said, “I don’t watch the clock. When I get done, I’m done.”

“I wish I could do that. I keep thinking about the people who are waiting for me.” A different idea popped up. “Did you say your sister’s an attorney?”

“Yes. Marla. She’s in a family law practice with a law school classmate in Santa Fe. Why do you ask?”

“I don’t know. Do you talk to her often?”

“Yes. Maybe weekly. Why?”

“I talk to my sister at least that often. Natalie’s fourteen. She helps me stay on track, and understand situations that go over my head. It’s great. You can’t talk to your parents about some of the things you can talk to your sister about.”

“Family is everything,” Josh said. “Did you know that Ricky’s my cousin?”

“No. Our Ricky? As in our second-year resident Ricky?”

“Yes. I guess we are second cousins since we share a great grandparent.”

“What’s his name again?”

“Edward Roger Rickover.”

“Jeez. Ricky is much better. Have you guys been close for a long time?”

“No. But since I got here, yes. I have made a big deal of his initials being ERR.”

“What do you guys talk about?”

A mischievous face flashed. “Women, the other residents in our program, you, football, pizza, cars. All of the finer things in life.”

“Me?”

“What did you expect? Ancient Roman history?”

“Oh yeah, Einstein’s theory.”

Josh sent the question back, “What do you and Natalie talk about?”

“Clothes, men, people around us. Not pizza. Not you. Not cars.”

“We need to stop talking about pizza. You’re making me hungry.”

“I need to get to work. I’ll see you later.”

He watched her walk away. “You need to take your eyes off her,” a voice behind him said. “She’s jailbait.”

“Shut up Ricky,” Josh quipped. “I look at hummingbirds and it doesn’t mean I want one.”

“That,” Ricky said, “has nothing to do with this situation. You want her and you want her bad. The drooling is sometimes annoying.”

“Like with you and Haley? We all see that too.”

“There is one big difference, Josh. Haley’s not married.”

“Yeah. I don’t know how to handle that part. My attraction to her is not fading, and yet she’s forbidden fruit.”

Ricky chuckled. “Be careful. Going to bed with someone else’s wife can get you lead poisoning.”

“Oh, you mean hot, high-velocity lead?”

“That kind.”

“Yeah. I guess I just have to look at her like I look at hummingbirds and New Mexico sunsets.”

“Good idea. Avoid lead poisoning.”

Chapter 7

Brian Yankton was the attending of the day, and stood with the troop of trainees for morning rounds. To his surprise, a stranger appeared, who quickly got the attention of the group.

“Good morning. I’m Margarita Valdez, a retired obstetrician from Crystal Springs, which is about 150 miles east of here in the middle of nowhere. The main products of Crystal Springs are cactus and sagebrush. Not really, it’s oil and agriculture. I delivered babies out there for almost forty years, and many of you have talked to me on the phone when I needed to send patients here for specialized care. Your director, Emily Beacham, asked me to fill in here as attending and supervisor for a few months until a permanent faculty member is recruited. Please help me learn your routines, your names, and the location of your bathrooms.”

A smiling face said, “My name is Ann McCauley, and I’m the second-year fellow in high-risk obstetrics. I’ve talked to you several times on the phone and I’m glad to finally meet you.”

Brian Yankton stood silent.

“Yes, Ann. I remember you. You should call me Peggy.”

“The last patient you sent us was a lady who was on dialysis for kidney failure. I can’t believe the number of complicated patients you had in that little town.”

“There were amazingly twisted issues out there. It’s what kept me going for so long.”

“I’m Josh Menkowicz, Dr Valdez. I’m a first-year resident. Glad to meet you.”

“Thanks, Josh,” Peggy said. “You guys should all call me Peggy.”

“I’m Faith Pernitelli,” a tall, dark-haired woman with bright eyes said. “I have a lot to learn. I ask lots of questions which seem to unsettle some people. Please don’t be unsettled.”

“Questions don’t bother me. I will do my best to answer. If I can’t answer today, I’ll answer tomorrow.”

“I’m Edward Rickover, but people call me Ricky. This is Haley Denton. I’m a second-year resident, and she’s a third-year resident. She has a serious birth defect — freckles.”

“Shut up Ricky.” There was some snickering.

Faith started the presentation of cases. “Today, we’ll have a repeat cesarean section and a post-partum tubal ligation. The cesarean patient has had two previous cesarean sections, and the baby is large, over nine pounds, but she doesn’t have diabetes. We also have someone in labor who will deliver in the next few hours.”

“Why did you think it was important to tell me the patient didn’t have diabetes?” Peggy asked.

“Because patients with really large babies often have diabetes, and having diabetes would change how you manage the patient after her operation.”

“Good job, Faith,” Peggy said. “What else do we have?”

Ann said, “The only ante-partum patient we have — that’s what we call pregnant patients in the hospital for reasons other than delivery — is Beatrice Castro who has an asthma attack at twenty-two weeks. She didn’t respond to breathing treatments in the emergency room, so we brought her here for more medicines and support. I discovered that her problem is that she has not been able to afford a steroid inhaler.”

“Can she get to Juarez?” Peggy asked, referring to the Mexican city located just across the Rio Grande from El Paso, a four-hour drive from Albuquerque.

Ann said, “I didn’t ask her. What are you thinking?”

“Steroid inhalers are cheaper in Juarez,” he said.

“Is that something I should suggest?”

“I would think so.”

“Did you do that routinely in your practice? We don’t need ICE picking up our patients trying to cross the border.”

“I did suggest that to my patients, because asthma medicines, insulin, and oral contraceptives are way cheaper. At least from Crystal Springs, patients could always buy goods and visit relatives without interference from Border Patrol.”

“I’ll ask her about that,” Ann said.

“And theophylline,” Peggy said. “An old, safe, cheap medicine she can take orally twice a day.”

“I don’t know that one,” Faith said. “What is it?”

“It is a caffeine-like drug we used to use all the time. Older folks get heart complications from it, and it makes toxicity in children if not used carefully, so it has fallen out of favor. But pregnant patients, with their huge increase in kidney function, don’t get toxic and are young enough not to get heart events.”

“I’ll use that,” Ann said. “How much do you give her?”

“Maybe 300 milligrams twice a day. Adjust to effect. You can get blood levels if you want to, but usually I don’t.”

Heads and faces indicated that rounds had been good. Faith said, “Afternoon rounds are here at four, Peggy.”

On that note, the group divided up the work and scattered to their duties. Departing, Ann said to Peggy, “We’ll have a good time with you. You already put a dimension on care we hadn’t thought about or discussed for a long time. It’s that kind of input we need.”

“That’s easy. I feel like my brain is bursting with gems I need to give someone. It will be fun to dump them on you guys.”

“We’re ready.”

“I’m supposed to have a desk in the ‘fellows’ closet,’” Peggy said. “Would you mind telling me where that is?”

“I have to go there now anyway, so we can go together. I wondered why they crammed another desk in there earlier this week. I have to warn you, I didn’t think there was room for a fourth.”

They headed down the hall into an older part of the building. An aging, carved, wooden door with a frosted glass window labeled “Private” creaked open into a small, bare room. Four metal desks with ancient wooden rolling chairs shared the space, in one of which sat Brian Yankton.

“Peggy Valdez,” Peggy said extending a hand.

“Brian Yankton.”

“Are you the third-year fellow?”

Brian made clear he was insulted. “No. I’m an attending. I thought they would give you a real office.” He looked at Ann. “Did you know she was coming?”

“Yes,” she said. “Emily told us in a meeting a week or two ago.” She sat at her desk, while Peggy organized her desk. “You were at that meeting, Brian.” The conversation stalled, but Brian sat still. “What do you want, Brian?” Ann said.

“I just wanted to talk to Dr Valdez, but alone.”

“I have a few minutes of work here, Brian. Why don’t you make an appointment with the lady and talk to her at her convenience?”

“Why are you always so insulting, Ann? She’s my peer, and I guess this is her office.”

“I don’t see it that way. You are the junior faculty. She is the senior. You should show some respect and consideration. It’s her first day, and something tells me you are not the welcoming committee.”

Brian said, “Dr Valdez — and Ann, you should call her Dr Valdez, too — when would be a good time?”

“Any time is fine,” Peggy said. “I will be here for a while figuring out my computer and organizing. I don’t have any responsibilities until rounds at four this afternoon.”

“Is it all right if I just wait?”

“Certainly.”

Brian stayed seated. “This seems like a demeaning place for you. Don’t you think it’s awful?”

“No,” Peggy said. “It has just what I need and it’s temporary. Emily said I would be needed less than a year.” She looked at Ann, “The ‘fellows’ closet,’ is that a term everybody knows? So, I could say, ‘Meet me in the fellows’ closet,’ and everybody would know what I’m talking about?”

“Yes,” Ann said, nodding.

“Where are you from, Ann?”

“Detroit.”

“Where did you go to college?”

“Wayne State.”

“Where did you go to medical school?”

“Case Western.”

“Where did you do your residency?”

“Here.”

“Did I make you feel like you were being interrogated?”

“No. But now back at you. Where did you go to college?”

“University of Colorado, Boulder.”

“Where did you go to medical school?”

“Washington University in St Louis.”

“Where did you do your residency?”

“Columbia-Presbyterian in New York.”

“Where did you do your fellowship?”

“I didn’t do one. When I trained, this specialty was called ‘Perinatology’ and it was rudimentary. We didn’t have a pregnancy test, we didn’t have ultrasound, and we were just beginning to use fetal monitors.”

“Gad. I can’t imagine.”

“I can’t either,” Peggy said. “The change in the specialty during my career transformed it. Nowadays, we never have surprise twins, we can diagnose tubal pregnancy before it ruptures, and we have almost no stillbirths. We know when a child with a heart defect is coming and can get ready.”

“You didn’t have that before?”

“Shoot no. Neonatal ICUs weren’t what they are now, either. We could only save premature babies after thirty-two weeks. Now we can save twenty-four weekers, a drastic change for the extremely premature.”

“That’s amazing. Well, I have to get going. I’ll talk to you later.”

“Bye.”

Brian remained seated. “I don’t know why you’re here.”

“I was assigned this desk, and it’s a place I can read, update myself on patients, and—”

“No, not in this room. Why are you here at this medical center?”

“I’m not sure what you want to know. I was invited by Emily to provide extra help. My assignments include taking call and being generally instructive.”

“But you are not qualified to do that,” Brian said. “What qualifies you to be on our faculty?”

“Well, I have a lot of experience, have prided myself in learning all I could, and I enjoy fetuses.”

Brian turned his back to Peggy and paced like an attorney questioning a witness, negotiating the tight quarters like Packman on the chase. “Are you board certified in obstetrics and gynecology?”

“Of course. For forty years.”

“Are you board certified in maternal-fetal medicine?”

“No, anesthesiology.”

“Then you are not qualified to be here.”

Peggy said, “I didn’t make that decision. Everybody knows that I’m not boarded in maternal-fetal medicine, and I’ve never told anyone I was. Are you board certified in maternal-fetal medicine?”

“No, I’m—”

“Are you board certified in obstetrics and gynecology?”

“No, but I—”

“So, then, what’s the real question?”

“You are not qualified to be on our faculty,” Brian said. “Someone of your age and experience should be board certified. It’s unconscionable that you are parading around with fellows, residents, and students claiming to be someone you aren’t.”

“First, I don’t parade around claiming to be a maternal-fetal medicine specialist. Second, I plan to carry out my assignment until the people who hired me tell me differently.”

“That’s ridiculous.”

“Perhaps we should have this conversation with Emily. I would be glad to set that up.”

“Emily Beacham? You call that a division chief? She’s part of the problem,” Brian said. “She’s the one who invited you. I don’t know why she thought you would be a good addition to our ranks when it’s clear that you’re not.”

“In what way, besides certification, do you think I’m lacking?”

“When you talk about sending patients over the border for medicines, when you suggest antiquated drugs like theophylline, and when you think you can instruct fellows. How can someone who has never done a fellowship instruct people in a fellowship?”

“Perhaps we should have a meeting with Dr Beacham. Maybe we can iron things out. I would be glad to arrange that.”

“I was thinking Dean Rhodes.”

“No. Departments and divisions are not democracies. It is not your responsibility to police or rectify irregularities in the faculty structure of the University. There are people assigned to do just that.”

“But this is so urgent and so blatant, that it needs to be corrected,” Brian said.

“Well, I’m not willing to skip levels of command in this situation. The correct way to work toward a solution is to start with the division chief, progress to the department chairman, then to the dean of faculty, and finally to the dean. Am I correct that you have discussed this with no one besides me?”

“Yes.”

“Then no one has refused to address this problem for you,” Peggy said.

“For me? For me? This isn’t about me! It’s about you! And you could solve the whole problem in a heartbeat by getting out of here!”

“Gosh, I’m sorry for causing this disturbance,” Peggy said. “Emily Beacham, the chairman, the dean, and several other faculty members were all involved in my invitation.”

Brian amped up his argument, “That doesn’t clear the qualification problem. You are not qualified to come here and assume any kind of patient care. This is despicable.”

At that moment, Peggy became physically afraid of Brian. She stood, backed up a step, and pushed her chair under her desk.

“Forget it! Forget it! I’ll take this to a higher level. But you have been warned. There will be consequences!”

With that, Brian spun on his heals, left the room, and slammed the door rattling the frosted glass window.

For Peggy, this was a confusing interaction. Brian was not in an administrative position of any kind or at any level. There were people entrusted by the University to select and groom faculty. The position Peggy occupied was a temporary one, just to bridge from a faculty shortage until new players were recruited and on scene. She didn’t need the job. Being terminated on short notice would be no insult or inconvenience, since she could scamper back to Crystal Springs, resume her role as great aunt, spouse, and citizen. There had to be more to the story than lacking board certification in high-risk obstetrics.

Chapter 8

Brian was on the couch when Faith plodded through the door, the aroma of popcorn striking her nose like a buzzing insect, awakening an appetite.

Brian said, “You missed dinner. Why don’t you call when you’re not coming?”

“Sorry. I didn’t think you would be here. Aren’t you on call?”

“Yes.”

“So why are you here?”

“Nothing is happening. They have five people in the building all night. They don’t need me. I can talk to them on the phone. We live close enough that I could get there quick enough anyway.”

“I thought the rule was you had to stay in the building,” she said. “I know for sure that residents have to stay in the building. What if you get caught?”

“I don’t think anyone told me I had to be there. I’m going to assume I have the freedom unless someone tells me otherwise.” She heard what he said, but she didn’t believe him.

“I smell popcorn,” she said, finding a place on the couch next to him, and helping herself to popcorn. “What are you watching?”

“A movie. It just started. Kevin Costner is chasing a serial killer. He doesn’t know it yet, but it’s a woman.”

“Oh, OK. Who’s the young guy?”

“His partner.”

She helped herself to more popcorn. It didn’t taste as good as it smelled.

Costner was about to serve a search warrant when Brian’s phone rang. “Hello.”

A clear, wispy, feminine voice said, “Hi, honey. What time will you get to Dallas on Friday?”

“Can I call you back? In maybe an hour or two?”

“Just tell me and I’ll hang up.”

“Midnight.” Brian ended the call.

Faith stood. “Who on earth was that?”

Without looking away from the television, he said “I’m going to an ultrasound conference this weekend. I made a hotel reservation for Friday night since the conference starts at eight in the morning on Saturday.”

“A hotel reservation clerk doesn’t call you ‘honey,’ and doesn’t call at eight thirty at night. Even I don’t call you ‘honey.’”

“That’s someone who is also coming to the conference.”

“Who you’re screwing? Is that the chlamydia lady?”

“No.”

“Yes.”

“No, I swear.”

“I can’t take this anymore. Get out of this apartment. Get out. Tonight. You’re a jerk. You’re never touching me again, and you’re never coming back. Get out.” Wetness trickled down her face.

He still hadn’t moved. “This is my apartment. If it upsets you that much, you get out of this apartment.”

“No. I am not the cheater in this house. You are. You need to get out of here. Get all you need for tonight and the whole weekend and get out. Don’t come back.” She started pitching things off his desk and off the floor onto his lap.

Brian moved like a shamed dog, slinking to the bedroom. In less than fifteen minutes, he was back out. “Where do you expect me to go?” he asked dragging a roller bag and a jacket. “Out with the homeless?”

“Sure, fine. You have money. Get a hotel room for tonight and tomorrow. Then head for Dallas for your weekend romp, then come back and find an apartment. With what the University pays you, you should easily be able to afford one. If the homeless suit you, OK by me.”

“Aren’t you nice?”

“Be sure you take everything you need for your conference. Take your reservations, your flight info, and your ID.”

“I’m driving.”

“OK. Take your keys. Get out of this apartment.”

The shamed dog gently closed the door on the way out. She plunked on the couch with her legs under her and turned the TV off. She used several tissues, dripped mascara on her shirt, and finally went to bed. She wasn’t up for “I told you so,” from Natalie tonight.

Chapter 9

Brian Yankton barged into the fellows’ closet rattling the frosted glass window and shattering Peggy’s concentration. He stepped up to Peggy’s desk.

“Her Majesty Division Director Emily Beacham told me to talk to you.”

“I’m ready. What’s on your plate?”

“She threatened to terminate me.”

Peggy leaned back in her chair, took a long pull on a Diet Mountain Dew, and waited. Brian pulled another rolling chair up. “Have a seat,” Peggy said, “I think we need to start over. The way we left things last time was hostile and turbulent. We need to be on more congenial footing.”

“Yes, perhaps.” What kind of congenial footing needed to be established? She’s just an unqualified temp.

“Tell me some more about you. Where are you from?”

“Brownfield, Texas. Not far from Lubbock.”

“Where did you go to college and everything?”

“College at Texas Tech in Lubbock. Medical school, residency, and fellowship there also.”

“What got you here?”

“This job.”

“How has it been for you?”

“I’m getting pressure to do more and to integrate into the division.”

“From whom and to do what?”

“Get involved in a research project, take up some medical school or departmental administrative duties, or — ”

“Who’s applying the pressure?”

“Emily.”

“Didn’t you have to do a research project to complete a fellowship?”

“Yes.”

“What was your project on?”

“The second stage of labor,” he answered, referring to the time from when the cervix is ten centimeters dilated until the baby delivers, involving pushing, changes in position of the baby’s head, and stretching of tissues in the birth canal.

“How’d you get interested in that?

“One of the faculty was studying it and had written a few articles on it.”

“It’s a great topic,” Peggy said, “which has been sorely neglected. We probably just do what we’ve always done and not what’s scientifically sound. As far as I know, there’s almost no science on that subject.”

“Correct.”

“From an anesthesiology standpoint, it’s also an important topic. We need to know how to manage the second stage, since, in my experience, it is vastly different from the first stage. An epidural can have either a confounding or a facilitating impact on how someone pushes a baby out.”

Brian didn’t respond.

“Why did Emily want you to talk to me?”

“I failed my written Ob-Gyn boards.”

“One failure is easily overcome.”

“It’s worse,” Brian said, “this is my second time.”

“Uh-oh.”

“I’m not sure why she wants me to talk to you, of all people.”

“I don’t either. Tell me more about that conversation.”

“She didn’t talk to you?”

“No.”

“She said that I’m required to pass my ob-gyn and my maternal-fetal medicine boards, or I will be terminated. Board certification is required for faculty status here. Which brings up to why you are here.”

“I am filling in for a desperate temporary need. I am qualified by the years of service I put into a practice which was almost completely obstetrics, and on which I worked hard to gain knowledge and skills to accommodate the high-risk pregnant patients in an under-served part of New Mexico.”

“So why do you think board certification is required of me?” Brian asked.

“Two things come to mind. First, it’s the current standard that people who practice have post graduate training and have been vetted to insure competence. Second, I expect the University views you as permanent. You are someone who could well spend a whole career here and they want career folks to be objectively qualified.”

“Why does that exempt you?”

“Where would the University get somebody for an indefinite time period, dedicated to this department, and who knows they will be abruptly terminated as soon as a permanent replacement is hired? For me, it doesn’t matter if she tells me tomorrow that she doesn’t need me anymore. So, I think she settled for a disposable, uncertified, warm body.”

“But you don’t seem to feel that way, from all outward appearances.”

“No. I want to do a good job, I want to fill the needs of the department, but I don’t want a career. In a year, I imagine I will be out of energy again, and it will be time to quit.”

“I didn’t perceive you had that view.”

“Let’s get back to board examinations. What happened?”

“I was weak in gynecologic oncology. What she scolded me about was that I didn’t pass the obstetric module.”

“Uh-oh,” Peggy repeated as eyebrows rose.

Brian continued. “On the first go-around, I did pass the obstetric module, but I was weak in gynecologic oncology.”

“Cancer was never my favorite either. I can understand that if you focused on obstetrics, you likely let some of your cancer knowledge slip. You can bone up on that a little. There are practice tests with answers on the national website that you can use, with lists of recommended reading.”

“I only have one more chance, and then I am not eligible to take any more tests.”

“Then you’re screwed,” Peggy said. “Let’s get back to the test. What do you think happened?”

“I haven’t been reading or concentrating well.”

“Is that new?”

“I think it is.”

“Do you know what is going on?”

“No.”

“Are you happy here in Albuquerque?”

“No.”

“Tell me more about that.”

“Faith was planning —"

“Faith?”

“My wife.”

“As in our Faith Pernitelli?”

“Yes.”

“You’re married to Faith Pernitelli?”

“Are you surprised?”

“Yes.”

“Are we that different or that incompatible?”

“I can’t envision you two together. I had no idea you two were married. Anyway, Faith.”

“Faith was planning to go to Texas Southwest Medical Center in Dallas for her residency, or to stay in Lubbock. When she did her match, she put Texas Southwest first, Lubbock second, and Albuquerque third — or so I thought. Now, I find out, she didn’t put Lubbock on the list at all. I think we were both stunned when she didn’t get selected by Dallas but matched here. At first, I thought about staying in Lubbock, but at the last minute, I got a position here and the pay was better, so I signed up.”

“How does she like Albuquerque?”

“She loves it,” Brian said. “But for me, the department doesn’t have any major research thrusts or grants, it’s not a facility that has wide scientific connections, and the mentoring is weak.”

“Don’t you think that the way you have addressed me might obstruct any mentoring that’s available? Have you been similarly hostile to the other faculty?”

“No. But what could you offer?”

“Unlike the other faculty here, I have time. I can help you learn how to find out about something you don’t know anything about, I can offer alternate views of our daily medical challenges, and a list of career mistakes to avoid.”

“How does that help me?”

“It refocuses you on educating yourself. No one can teach you, you know, you have to learn it. Once I figured that out, it was smooth sailing. It’ll be a sink hole of work, time, and money, though.”

“I still don’t see how you are who she suggested I talk to about my exams.”

“How were your in-service training exam scores? What were the scores on your first failed test compared to your second failed test?”

“I took the in-service exams each year in my residency, like everybody does, and I consistently improved on each one. When I got to the first board exam, my score was worse than my last in-service exam. Aren’t they supposed to be the same or similar tests?”

“That’s the impression I had.”

“My second fail was worse than the first.”

“Uh-oh.” Up went the eyebrows again.

Brian’s chair squeaked, but he said nothing.

Peggy said, “So that suggests that reading, studying, listening, and interacting at rounds is not the problem. It suggests there’s a deeper problem.”

“So maybe Albuquerque?”

“You know, I think it’s even deeper than that. Are you and Faith getting along? Are you drinking too much? Are you depressed?”

“None of those.”

“That’s what I thought. So, we need to figure out which of them is the root cause.”

“I thought I said none of those.”

“Your face didn’t. Your pupils are small, not like the last time I saw you, but still, too small for the light in this room. Are you on opiates?”

Brian’s posture reflected the blow. He couldn’t resurface for a breath, but came up with an improvisation. “Wait. I came to talk about board scores, not personal life. This is not what I came for.”

“Actually, it might be exactly what you came for. Maybe you should have a serious talk with Emily about the deeper issues. She has the advantage of administrative leverage I don’t.”

“Well, maybe this conversation was a bad idea,” he said, rising.

“Don’t go yet,” Peggy said. “Have a seat. Tell me more.”

Brian turned back but didn’t sit. “I’m not sure where this is going. Why are you probing my personal life? I came to discuss my professional standing, figure out how to get Emily off my back, and figure out what it is she wants me to do.”

“Maybe we should tease this apart a little more.”

“What do you mean?”

“What does Emily expect?”

“Pass my boards. Start a research project or join with another faculty member on their research project. She also suggested helping Juan, who is the Dean of Students.”

“What would you like to do?”

“Pass my boards.”

“What else?”

“I don’t know. I don’t like Juan. My research project in Lubbock was a pain because my director made me reanalyze data and rewrite and rewrite and rewrite.”

“Wasn’t it a learning experience?”

“Yes. Learning that I don’t like research.”

“That you don’t like research? Or that the learning curve was steep.”

“I don’t like research. I didn’t think it was all about learning at all. It was jumping through hoops of our own creation. Hoops don’t make sense to me, they’re just hoops. They didn’t have any point and weren’t educational.”

“Have you ever done any departmental or medical school projects?”

“No.”

“I imagine it’s rewarding. But there may be a steep learning curve there also.”

“I don’t mind learning curves,” Brian said.

“Most people hate them. At least I do. I endured them to get to the final product. So did you.”

“What do you mean?”

“You went to college, medical school, did a residency, and completed a fellowship. Those all have learning curves you must endure and hoops you must jump through to get to the final product.”

“Learning those things left you with tangible results. At the end, I could operate, do ultrasound, and manage complicated pregnancy.”

“Don’t you think learning will go on indefinitely? You are going to use technology and know more about diseases than we can even imagine at this point. Look at me. Ultrasound was a dream when I was in medical school. Tools like that are coming your way, and you will have to learn them to keep up, just like I did.”

Disgust coated Brian’s face. “Can’t I just hunker down, take care of patients every day, and go home at the end of the day?”

“No. You have to be aware of your surroundings. It might mean collecting data to see what works for your patients, and then sharing that with others, which is called research. Or, imagine inventing some kind of instrument to find out the amount of oxygen in a fetus’s blood. We would do a fraction of the cesarean sections for fetal distress because we could tell which fetus needed intervention and which did not.”

“It’s exhausting.”

“That’s what I meant when we talked about a deeper issue. It sounds like you are out of energy.”

“Sometimes I think that.”

“Is that new?”

“I don’t know. Maybe. Medical school was invigorating, Faith was exciting, residency less so, and fellowship was a drag. And here I am and all I want to do is go home.”

“Did you hear what you just said?”

“What did I say?”

“You have depression, and it is getting worse.”

“I didn’t say that.”

“How would you sum up the gradual decline you just described?”

Brian was silent for a time.

“Are you having trouble concentrating?”

“Stop! I need you to stop,” Brian’s voice declined with his posture. Energy spilled on the floor and headed for a drain, making whirlpools and sucking sounds on the way. “I have to think about this.”

Brian slowly got up, shook Peggy’s hand, and left the room. The frosted glass in the door rattled.

Chapter 10

“Dr Valdez, this is Faith,” came over the phone.

“What’s up?”

“I’ve got Betsy Melendez, she’s thirty years old and asthmatic, at twelve weeks with influenza B. We got a chest x-ray which shows pneumonia in the lower lobe of her right lung. The fetus is alive.” Faith felt a new lively confidence in her evaluation, her interpretation of the patient’s situation, and her newfound ability to concisely deliver the pertinent information. She also always enjoyed the interactions with Peggy.

“Do you want to keep her in the hospital?”

“I would, yes. She will need good isolation and monitoring of blood oxygen.”

By the time arrangements, phone calls, and territorial arguments had been settled, a good hour had passed before Ms Melendez’s arrival in medical ICU was confirmed. By that time Ann had joined them at the Labor and Delivery charting station. The three headed that direction. Intimidating sentry double doors with stern warnings bowed to a swipe of Peggy’s ID badge. A busy hallway with thirty beds, mostly occupied, held several bays with glass doors guarded by tall carts containing masks, gowns, and gloves, known as personal protective equipment, or PPE. The three dressed up and entered Betsy’s room.

“Betsy, this is Dr Valdez and Dr McCauley.”

“Thanks, Dr Faith. Am I bad sick?”

“Not yet, and we hope you don’t get that way, but we don’t want to wait until you are in distress to move you here. If you don’t develop a severe case, we’ll get you out of here.”

“Have you ever been in a hospital for asthma before, Betsy?” Ann asked.

“When I was a child, maybe four. The only thing I remember is the nasal oxygen and the steam tent.”

“Have you been using your steroid inhaler?”

“Yes. I’ve been a little wheezier for about a week, but not bad enough to need my other inhaler. I used my other one twice yesterday and four times today. I always have a little more trouble with my asthma in the winter.”

“Did you get a flu shot?”

“No.”

Faith said, “We’re going to check in on you in an hour or two. By morning we’ll know what’s going to happen. Do you have family?”

“Yes. They are in Farmington. I told them not to come until I found out what was going to happen. Knowing my mother, though, they’re on their way. It’s more than a three-hour drive.”

“Jeez,” Faith gasped, “did you drive all the way down here?”

“No, my sister-in-law brought me down.”

“You’ll get better,” Faith assured her. “We’ll take good care of you.”

“Is there anything else we can do for her?” Ann asked.

“We could give her theophylline,” Peggy said.

“You talked about that at rounds,” Faith said, stepping to a computer to enter orders. She leaned toward Ann. “Can you help me with this?”

“Sure,” Ann said.

Faith finished up with the computer and the three headed back to Labor and Delivery. On the way, Faith asked, “How do you know about theophylline, how it decreases the need for inhaled steroids, and all the stuff you guys seem to know?”

“You listen to patients,” Ann said. “And remember what happens to them. If you can’t remember what medicine you gave her, look it up so it sticks in your brain.”

“Read, read, read,” Peggy said. “Ann, she may need to take her theophylline for the rest of the pregnancy.”

Ann said. “I want to try it in a few of my office patients.”

“You will have to test it out for yourself. New drugs, or old drugs with new uses, will come along and you will have to decide whether to use them. Get real information from reliable sources, not from salespeople, figure out in your brain how they fit in your personal algorithms, and decide if and for whom you like them. Some you will kick out forever, some will transform the way you approach certain diseases.”

“How would I know theophylline is cheap?” Faith asked.

“Easy,” Ann replied. “Look it up in Facts and Comparisons or in UpToDate. Also, if it’s cheap, it’s on Walmart’s four-dollar generic list. walmart.com.” Ann giggled.

“Boy, I have a long way to go,” Faith said. “How did you get there? Peggy, how did you get all that you know in your brain?”

“I worked hard, read everything, looked up everything. Nowadays, you can find things so quickly on the internet. You must be careful where you find them, but if you stick to the subscription services, you’ll get reliable information. The University provides you with subscriptions to UpToDate, Facts and Comparisons, and the American Congress of Obstetrics and Gynecology videos and reading material.”

Ann said, “I’m five years ahead of you. You’ll catch up.”

“I’m more than forty years ahead of you.”

Ann patted Faith on the back. “You’ll get there. And I know that because you want to.”

Josh was sitting at the charting station when the three arrived. Ann and Peggy both soon departed.

Faith said, “I enjoyed Betsy, our influenza patient. She told me all about Farmington and a place called Shiprock. The tall mesas and rock formations sound beautiful. It would be fun to see them some day. She also talked about not having running water, and how a service comes by with a truck and puts water in a tank at their house. It is amazing that Americans still live that way.”

“It is amazing,” Josh said. “Did she say if they had electricity or a phone?”

“No, I didn’t ask her. That’s a good question. I can imagine that it’s hard to take good care of yourself like that. How do you take a shower or a bath? How do you care for a new baby?”

“How far does she have to drive to get medicine, even?” Josh asked.

“After she has her baby, are we sending her home in a day or two to a place that doesn’t have running water? I didn’t ask her because I didn’t think of it, but your point is a good one. Is she out there without electricity or a phone with a baby that’s two days old? I wonder if she even has a car.”

“Hard to grasp.”

“I really like working here,” Faith said. “We see patients from all walks of life. And our attendings let us manage the patients how we want, we just have to understand what we are doing and why. We can manage patients in ways that fit their lives, and not that fit the textbooks.”

“Emily, Peggy, and Ann are focused like that,” Josh said. “They’re more about understanding than about what treatment we pick.”

“Yeah,” she said.

He continued, “Yankton’s never into discussing or considering alternatives. Disease A is treated with B, disease C is treated with D. A computer — or a monkey — could do that.”

The mention of Brian made bile rise in her throat. Upending the marriage had upended her, and she knew that sooner or later she would have to confide in Josh. If she didn’t, it would spill out at an awkward moment or from an awkward mouth, like Haley’s.

She said, “I kicked my husband out.” Out of the corner of her eye, she saw Josh’s jaw drop open for just a second. “He had an affair. He promised he had ended it, but while we were sitting on the couch watching television and eating popcorn, she called to remind him of their upcoming encounter. I flew off the handle and told him to get out.”

“Wow!”

“He has been talking about re-uniting,” she said. “He seems to want reconciliation.”

“Are you OK with that? I don’t know that I could get over that.”

“I’ve been suckered into that twice already,” she said. “I don’t know how this heals. What keeps him from doing it again?”

“Good points. What do your parents say?”

“Mom’s convinced it’s over. I’m afraid she’s right. My father, who never really accepted Brian, just bad-mouths him.”

Josh said, “My parents wouldn’t be my go-to source of advice. My sister is better.”

“My little sister, Natalie, is only fourteen. She is surprisingly good at things like this, but also opinionated.” She took a breath. “I don’t know what to do. He promised he ended it, and that he wouldn’t do it again. But then came the phone call on the couch.”

“What did fourteen-year-old Natalie say?”

“Get rid of him. She said that a long time ago. Those weren’t the words she used, either.”

“You deserve better than that, much better than that.”

“Natalie said that, too,” Faith said. “I think I know where this is heading, I just don’t like the destination.” Her brain was about to spew a large amount of material on Josh, but the phone summoned her to an urgent patient issue, ripping her away from him.

Chapter 11

“Surprise!” Faith entered the conference room in the office building to noisemakers, whistles, clapping, and camera flashes.

A table, adorned with bright stripes, held a cake on which was piped a stethoscope, a pair of gloves, and a syringe. Gifts and cards were arranged to either side of the cake. Happy Birthday banners hung from the ceiling, and there were balloons all around the room. The setting was cheery, matched by the mood of the gang. They sang “Happy Birthday.” There were high fives, congratulations, cheers, and laughter.

After settling down, Ann served cake and Ricky served ice cream. An uncanny number of people was there, including several of the staff from Labor and Delivery and the office. Josh’s heart was warm, tickled he had pulled off a surprise birthday party no one leaked, and pleased with the ambiance.

Ann guided Faith to the gifts and cards, where she began opening them. The first gift was a short tube of “peanuts,” from which a cloth snake sprang eliciting a squeal — typical Ricky. One of the cards had a little envelope labeled “rattlesnake eggs,” which buzzed obnoxiously when opened, producing, “You guys!” from Faith and a blush from Haley. There were serious gifts, like an avocado slicer, ceramic beer mugs, and a Fitbit watch. The cards held classy poetry and silly jokes, gentle sayings and ridiculous thoughts, sacred words, and off-key suggestions. She thanked the individual for each item.

As the group adjourned, Josh helped Ann and Haley clean up the room. Ricky, with no ice cream left, ate the last piece of cake. Faith found a cardboard box in which to put her gifts and cards, then sat next to Peggy and Ricky as Josh wiped off and put up vacant folding chairs.

“You know Josh organized this, right?” Peggy whispered.

“Seriously?”

“I guess everybody loves you,” Peggy said in a bolder voice. “I’ve never seen a birthday party with such attendance and such nice, thoughtful gifts. You should be proud.”

“I don’t know whether to be proud or embarrassed,” she answered.

“Proud.” Peggy waited for her complete attention. “This is a loud message to you from your coworkers. Sure, you should be thankful, but more than that you should be flattered and proud. For me, this speaks volumes.”

“It’s nice,” she said. “I haven’t felt this way for a long time.”

Peggy held doors as Faith led and Josh lugged her box out of the conference room and toward her car.

“See you tomorrow,” Peggy said. “Happy Birthday!”

On the way to the car, Josh said, “Would you like to go to dinner with me? There is a great Chinese place near my house. And I like Mexican food. Actually, I like all food.”

“You bet,” her soft, velvety voice answered, melting his bones like candle wax in a hot room. “I like Mexican. What’s more, I haven’t had Mexican for a while. If you are talking about Padilla’s, that’s a really good place, and I can walk home from there.”

Josh put her box in the trunk, and the two enjoyed whack-a-mole with balloons resisting confinement in the car, popping a few in the process. Departing, she opened the driver’s window and, stuffing balloons back in, said, “I’ll drop my car at home, take a nap, and meet you at Padilla’s. Is six OK?”

“Perfect. I have a mountain of work to take care of before I can leave. I’ll call if I’m going to be late.”

Six o’clock couldn’t come soon enough for Josh. The loose ends took him less time than he predicted. On his way out, he bought a yellow rose in the gift shop, then headed for his car. Padilla’s came right up on Waze, and offered generous parking, although on gravel complete with potholes. Inside, there were several tables available, from which he selected an uncrowded area of the restaurant. When she entered, he noted she had changed into a running outfit. Of all the presentations. The Spandex top showed a hint of a sports bra and tic-tacs. The leggings were tantalizing. A buzzing hit his mind — or something.

She sat down across from him, and said, “Thanks for thinking of this. I needed it.”

Electricity sparked through his soul like lightning in Ben Franklin’s jar. He handed her the rose.

“Thank you,” she said. “I don’t know what to say.” She propped the rose in the menu holder.

“‘Thank you’ was good,” he said. “Happy birthday.”

“Thank you. Now I need beer.”

The waiter asked Josh for a drink order. Faith neither ordered a drink nor looked at the menu. Two large mugs of Negra Modelo appeared.

“Thanks, Julio,” she said.

“This is your go-to beverage?” Josh asked.

“Yes. Has been for a long time.”

“Me too!”

The waiter returned for Josh’s order. “Blue enchiladas,” he said.

“What do you want in your enchiladas, sir?” Julio asked, turning the page of the menu to show Josh the options offered.

Josh made a quick decision, “Mexican flag.”

“Good choice,” Julio said, “but those come with yellow corn tortillas. The blue doesn’t work out so well for those.”

“I catch your drift,” Josh answered. “I’m fine with that. Mexican flag.”

“Cute,” Faith said.

“Why didn’t they ask you?”

“Because I always get the same thing.” A look came on her face he was learning indicated a change of subject. “Tell me about your family.”

“Well,” he said, “my dad’s a dentist, my mom’s a nurse, and my sister’s a lawyer.”

“Are you from Oklahoma City?”

“No, Clinton, about 150 miles west. Halfway to Amarillo.”

“I don’t even know where that is,” she said. “Isn’t that awful? I’m from Lubbock and I have never been to Amarillo.”

“I understand that,” he said. “We rarely went west of Clinton.”

Delight burst onto his face when the enchiladas came. “These look fabulous. A red stripe, a white stripe with a black olive in the center, and a green stripe, the Mexican flag! They smell scrumptious.”

There was quiet as they ate. He caught her eye several times. She finally paused to talk. “I love these. They are so good. I always promise myself that I’ll try something else, but I can’t resist.”

He had to chew and swallow to respond. “Yes, they are spectacular. I see why you like this place.”

He insisted on paying the bill, left a tip on the table, and the two headed for the door.

“See you tomorrow,” she said without any gesture. “Thanks for dinner.”

“Hey, wait.” He handed her the rose.

She headed down the street and turned at the first corner. He got in his car, circled the block, and saw her walk up the sidewalk to an elderly duplex. He made a mental note of the location.

Josh drove the ten minutes to his apartment, thinking about the running attire. He dialed Ricky. “I don’t know if I told you, but Faith kicked her husband out,” Josh said after greetings and small talk. “We had a nice dinner at Padilla’s tonight.”

“I didn’t know that. So now’s your chance, right?”

“I thought so. I bought her a yellow rose, but I don’t think the message got across.”

“No,” Ricky said. “She’s kind of a nerd and things like that might go over her head.”

“Do you think she knows I organized the party?”

“I heard Peggy tell her.”

“Oh, good.” Josh paused. “She didn’t say anything about it tonight.”

“That doesn’t mean much. It was a big day for both of you. The evening might be a chill time, no mental strain, no deep messages, no heavy life philosophizing.”

“She came in a running suit,” Josh said. “She has a nice body.”

“If you just figured that out, then you’re dense.”

“I just can’t get over how beautiful she is, in more ways that the eye can see.”

“She is.”

“She didn’t go for her run, I don’t think, unless she was stopping in for an iPhone or something. She had two liters of beer.”

“That would do it,” Ricky said. “Did you drive her home?”

“No. She took off walking. It was only two blocks plus a couple of houses. She lives in a little duplex.”

“Now that you mention it, I might have known that. I think Haley knows the lady that owns the duplex and lives in the other unit.”

“Speaking of Haley, what are you planning?”

“I don’t know. I am not rushing it, and she isn’t either. We are both busy right now.”

Josh chuckled. “I wish I had some planning to do. First I have to get a message across.”

“A billy club? An M80? Maybe a greeting card?”

“I’m tired. I think I’ll turn in.”

“Tired. You had two liters of beer also, right?”

“Right.”

Chapter 12

As the resident group developed into a congenial unit, they fell into healthy habits, and learned to work as a team. Occasional evenings became their social time. Padilla’s little restaurant was close, cheap, clean, had good food — and Taco Tuesday. Over pitchers, chips, cheese dip, and guacamole, the group gathered just shy of seven in the evening. This night was dark, nippy, and sprinkled with bright stars as only New Mexico winter sky can be. Faith found Haley, Ricky, and Josh already established. Others joined them filling a long table finally growing to ten. A huge tray of tacos appeared.

“You didn’t order anything?” Ricky asked Faith, acting alarmed.

“I always get the same thing. They will bring me Negra Modelo. I like Tacos.”

Ricky leaned over to Faith and whispered so everyone could hear, “Are you and Josh going out?”

Faith blushed.

“That’s good enough for me,” Ricky exclaimed, proudly fist pumping. “Good catch, Josh. Try to keep her.”

“Are you getting a divorce?” Haley asked. The entire table immediately became silent, eyes on Faith.

Josh held his breath.

“I haven’t decided.” She tried to joke about it, “I was hoping Brian would file and pay for it.”

“Wait a minute!” Ricky said. “What Brian are we talking about?”

“What do you mean, Ricky?” Haley said. “Her husband’s name is Brian.”

Ricky made a theatrical face, “Is your Brian our Brian?”

Haley said, “Wait! What?”

“Are you married to Brian Yankton?”

Faith produced a sheepish, “Yes.”

For a moment there was silence. Haley, of course, was first. “How did we not know this?”

“We?” Ricky asked, “how did you not know this, Haley?”

“I swear. I didn’t know.” She turned to Faith, “How come you didn’t tell us?”

Faith shook her head, “Would you be proud? Look at how he argues at rounds and wants a phone call every time we go to the bathroom. He argues and degrades you and Ann in front of us at rounds.” Directly at Ricky, “How does everybody know about Josh and me, anyway? Was it in the newspaper or on TV or something?”

Ricky held his hands in the air, innocently. “Hey, I heard it from Haley.”

“Shut up, Ricky.”

Faith couldn’t think of how Haley came up with divorce. She didn’t think she had mentioned it to anyone. She wasn’t even sure she had thought seriously about it. It was always amazing what Haley found out, but more amazing she hadn’t made the Yankton connection.

More tacos quieted the group. Cordial banter followed, but with silent Faith. Since many of them were tired, it broke up early. Ricky and Josh talked, silent Faith listening, Josh hoping the whole time Ricky would go home.

“Did you tell Haley about the divorce?” Faith asked Josh as soon as Ricky was out of earshot.

“Oh, absolutely not. I don’t tell her anything. Besides, I didn’t know. More than that, you didn’t tell me Brian Yankton was your husband. And I’ve been badmouthing him to your face!”

“I’m not proud of it. Listen to the talk about Brian. Would you want to be connected? If they knew, they would clam up, I would be an outsider, and you wouldn’t have dinner with me in the cafeteria.”

“Wrong. I like you because I like you, not because, well—”

She drank the last of her second beer and looked at the ceiling.

“It explains a lot about things you have said and conversations you have avoided.” Josh finally said. “I don’t know where they came up with the divorce thing. Maybe it was a good guess on her part. I doubt it was from Brian since Haley didn’t know Brian was your husband.”

She calmed. “I just hope you didn’t tell.”

“Faith, I had nothing to tell. Honestly. You haven’t said anything to me about divorce, and I didn’t know our Brian was your Brian, as Ricky said.” Josh finished his beer. “Do you want to talk about Brian?” If she didn’t, he did.

She looked around the restaurant, now nearly empty. “Maybe.”

“You don’t have to tell me anything. It’s up to you.”

“Josh, what do you want to know?” He sensed her two liters of beer.

“Well,” he stammered, “I don’t need to know anything. I was just giving you a chance to vent.”

She didn’t respond right away. “Maybe. But not here.”

“OK. I’m game.” He waited for her lead.

They left the restaurant, meandering toward her apartment, which was also in the direction of his car. “We could sit in my car,” he suggested as he punched the unlock button on his fob. The car chirped and flashed its lights.

“OK.” She plodded toward the passenger door, flopping in like a rag doll.

“Did you hear from Haley that I was getting a divorce?” She was in the passenger seat looking forward out the windshield.

“No. Tonight was the first I’ve heard about it.” He looked squarely at her. “I try to escape gossipy conversation. More than that, I try to escape Haley. She needs a shut-up button. The only thing I knew was that you kicked him out, that it wasn’t the first time, and that your mom and sister think it’s over. Ricky knows we’ve been out a couple times.”

“I wonder how Haley found out,” she mumbled.

Josh let it go as rhetorical.

“Well, I guess it’s true that I need a divorce. It’s hard to admit to yourself that you’ve failed.”

“How did you fail? Did you do something?”

“Yes. I married him. I dragged him to Albuquerque.”

“How is that failure?”

She didn’t answer.

“You didn’t fail,” he said. “You can only do what you can do. You cannot control what he does.”

“No, I’ve never been able to control what Brian does. But sometimes I wonder if I contributed.”

“By being busy?” he questioned. “Who among us isn’t busy?”

“Still—”

Josh said, “He had an affair. Isn’t that how most marriages end?”

“That’s what my mother thinks. She’s been particularly vocal about it.”

“I’m sorry.”

“Have you ever been married? Have you ever had an affair? Have you ever had a nasty break-up?”

“No, yes, yes.”

She giggled. “You’ve never been married, you’ve had an affair, and you’ve had a nasty breakup.”

“Yes, yes, yes.”

“Do you want to tell me about those?”

“Well, I’ve never been married. I’ve never been engaged or seriously contemplated getting married because I focused on my education, and I didn’t want anything to get in the way of it. I’ve had two affairs. One lasted several years, but we drifted apart ending in a nasty breakup. I felt terrible, she felt terrible, and the great relationship I had with her dad and brother made it even worse. Best camping buddies ever. I loved her family, but I didn’t love her.” He paused, but when she didn’t respond, “There!”

“Confession is good for the soul,” she said, looking at him, warming his heart. Her bangs hovered over two-liter glassy eyes. He didn’t know if it was her persona or her physical appearance, but either way, it energized his soul — or something.

“So,” she began, “Brian and I got together when he was a resident, and I was in college. After I graduated, we got married. Our families were happy, but my dad never really clicked with Brian. I started medical school and Brian finished residency and started his fellowship. I think he met her as a resident.”

“Then…”

“He told me he broke it off.”

“Heard that before.”

“I know he didn’t.”

“How did you figure it out the first time?”

“Can I trust you?”

“Yes.”

“Josh,” she said, tilting her head, “Seriously! Can I trust you?”

“Yes, of course.”

“I went for a contraceptive visit and had chlamydia.”

“Shit.”

“Yeah, shit, all right. He denied there was anything wrong with him, tried to blame me, but I made him take the medicine my doctor gave me for him. And worse, my doctor was Dr Scroggins.”

“Our chairman, Dr Scroggins?”

“That one.”

“Then what?”

She looked disgusted. “He begged, promised he wouldn’t ‘ever never do it again,’ so we got back together, and he moved back in. It was after only a week or so. I don’t know what I was thinking.”

Josh shook his head. “If someone did that to me, I’d be totally finished with the relationship.”

“When I kicked him out of the house it was the angriest I’ve ever been.”

“What tripped that?” Josh probed.

“The phone call with the popcorn.” She got quiet. He handed her a tissue.

“Phone call with the popcorn?”

“Yeah. I came home from work. You and I had eaten in the cafeteria. He was supposed to be on call, so I thought he had to stay in the hospital all night. When I got home, he was sitting on the couch watching a movie and he had made popcorn. I took my first bite when the phone rang, and I heard her voice.”

“Faith, I’m sorry. Is this the same woman as the chlamydia, or a different one?”

“I don’t know. I would bet it’s the same one, but I don’t know for sure. It was like he stabbed me in the heart. I couldn’t think. I thought about throwing a chair at him or hitting him with something.”

“But you kicked him out?”

“Yeah. He didn’t even put up much of a fight. He hasn’t been back since, nor have we talked since.”

Josh wanted to ask about a pointed exchange with Brian at rounds recently, but he decided that didn’t constitute ‘talk’ the way she used the word. “So, what has happened since then?”

“Nothing.”

“You weren’t responsible. What he did, he did. You get to keep your dignity.”

“Do you know anything about divorce?”

“No, but my sister’s a lawyer in Santa Fe. You could talk to her.”

She perked up, “Really?”

“Yes. She once told me how to use one of the online services if you don’t have any assets in dispute.” He watched her face, now turned directly to him. “I don’t remember how to do that, but she does.”

“I need to know how to do that,” she said.

Josh grinned. “I can make that happen.”

Marla spoke on speaker startling Faith, “Joshua, what’s up with you?”

He spoke more loudly than he had been speaking to Faith. “I have a classmate — in my same residency year — who needs a cheap divorce.”

“OK.”

“What did you tell me before about on-line services?” Before she could answer, he introduced them. “Marla, this is Faith. Faith Pernitelli, this is Marla Menkowicz.”

“Nice to meet you,” Faith said.

“How about if I send you a template I use in my office. She fills in the blanks, dates, and addresses, signs it, and then sends it back. It belongs to me, so I don’t want it distributed.”

Josh opened another issue. “What will you charge her?”

“Nothing if she’s doing this to marry you. One hundred dollars if she has other ideas.”

Josh started laughing.

Faith’s momentary panic resulted in, “I’ll send a hundred dollars tomorrow.”

“Faith, Marla is joking. Don’t read too much into it. She’s our family clown.”

“I’m not a clown,” Marla said. “Joshua, you need a good woman.”

Josh didn’t want this conversation to go too far, so he said, “Thanks for your help, Marla. Here’s her e-mail address.”

He moved the phone closer to Faith who recited her address.

“I’ll send a copy to you, too, Joshua, in case you married that bimbo you followed around in college and I don’t know about it. Seriously, Faith, he was like a puppy.”

“I was not!”

“Were too.” “Were not.” “Were too.” The call ended.

Faith sat up straight. “I can’t believe you did that!”

“Why not? You don’t have to use the template, you don’t have to get a divorce, you don’t have to do anything. But now you’re empowered.”

“Mm. I like empowered.”

“Then why the tear?”

“I still feel like there’s a hot knife in my chest,” She blotted her eyes with a tissue, “and there are two liters of beer in my tummy. See you tomorrow.”

She hadn’t unlatched the door yet when her phone rang, startling them both. She put it on speaker.

“Did you change the freaking locks already?” Brian’s voice was unmistakable.

“Yes.”

“I need to get my things.”

“OK.”

“How about now.”

“OK.”

“I’m here now. How soon will you get here?”

“A couple of minutes.”

Josh touched her shoulder, “I’m coming with you.” He oozed his car around the corner, down the street, and into a space in the front of her duplex and walked her in.

She greeted Brian at the door, speaking slowly and softly. The night-after-call and two liters of beer dulled her voice and her ire.

“Who are you?”

“You know me,” Josh said, taunted. “Josh Menkowicz, first year resident.” Seriously? He can’t make that connection? Brian didn’t respond. Josh wondered how much beer, or whatever, was in Brian.

Faith opened the door, turned on some lights, threw her coat on the arm of the couch, then planted herself on the couch with her legs under her, a familiar pose. Josh commandeered a barstool. Brian strolled over to the teak desk and began removing drawers, making grunting noises.

“Aren’t you going to help me?” Brian asked.

She shook her head. “I wasn’t planning on it. I wasn’t planning on you being here tonight.”

“You’ve been such a pain about this.”

“Chlamydia? Affairs? Condescending attitude? The way you treat all of us at rounds? I haven’t been a pain.”

“I didn’t give you chlamydia! Now that you have spilled the beans, he knows about it,” gesturing to Josh.

“I didn’t get it from a toilet seat, numbskull. We both know you’re the one having the affairs.”

“I don’t have chlamydia. There isn’t anything wrong with me.”

“Do you have any concept of how many times I’ve heard my patients tell me their men said exactly those words? You’ve heard those words too, idiot!” She turned her head away from him. “Just get your things and go!”

“Can you help me with this?”

“I don’t think so. Use your hand truck.” She held her place on the couch. Josh stayed on his barstool at the kitchen counter like a buzzard waiting for its prey to die.

When Brian was finished, he turned to her at the door, “I’ll come another time for the desk, chair and bookshelves.”

“You don’t get the bookshelves. I bought them, remember?”

“I’m taking them. Everything is community property. I want my half.” His face was red.

“Call before you come.”

“Bitch.” The door slammed.

“Is he always like that?” Josh asked.

“No. Yes.” She didn’t look up. “He was always a little like that, but he has gotten worse. In the last few months, especially since the chlamydia, he has really gotten impossible to get along with. It’s like whatever I want or ask, he takes the other side. I finally got to where I don’t have any meaningful conversations with him. He used to always run with me, but he stopped that a year or two ago.” She wiped more tears.

“Did he ever hit you?”

“No. There were a couple of times I thought he might. One time I slipped out of the apartment just to end a fight. I don’t even remember what we were fighting about, but he went to the bathroom and I left and went for a run. When I got back, he was in bed.”

Josh moved to the couch to sit next to her, but she moved over, not the response he expected or the one he wanted. She wasn’t ready, he guessed.

“You need to go,” she said without looking at him. “I’m tired and I want to go to bed.”

“No problem,” he said getting up, slipping on the jacket hanging on his barstool. “I’ll see you tomorrow.”

She didn’t say anything else as he left. At home, he couldn’t sleep. He tried to read, but couldn’t concentrate. He could feel the hot knife in her heart and the two liters of beer in his belly.

Chapter 13

Josh sat in Padilla’s at one of the back tables nursing a large mug of Negra Modelo, a basket of chips, and a dish of cheese dip. He had flipped through weather, texts, and news headlines on his phone when it finally rang.

“Sorry, I’m on my way now,” breathless Faith said.

“It’s OK. There might not be any beer left when you get here. It’s draining away fast.”

“There’d better be! I need a little. Is anyone else coming?”

“No. I didn’t ask anyone.”

“If you want to order, you can. I should be there soon enough. I’m already in the car.”

“Tamales and rice?” he teased.

“Hamburger and French fries.” A raspberry followed.

The waiter knew what to say, “Blue chicken enchiladas and a Mexican Flag? Do you want the other Negra now?”

“Yes and yes, Julio.”

Through a wide grin came, “Bueno.”

She soon flew in the door, sat, looked at the liter of beer in front of her, looked at Josh, and let out a big breath.

“Hard day?” he asked.

“Not really,” she answered. She took a huge pull on the beer. “Just got busy right at the end.”

He lifted a rose from its hiding place.

“A yellow rose.” She looked at it, looked at Josh, and got misty and flush.

“I’m sorry,” he said, panicked by the reaction. “I didn’t mean anything serious or complicated by that. I’ll take it back.” He reached for the rose.

“No!” she said, retracting the rose. “I’ve not been listening to you. You have been telling me that you are—”

“I’m sorry,” his alarm refusing to silence. “I didn’t mean to upset you. I may have sent a signal I didn’t mean to send.”

“No!” she blurted again. “I haven’t been listening to your signals. It was my fourteen-year-old sister who helped me know what you were signaling the night after my birthday party. I want to have a relationship with you. I don’t care what Haley or Ricky or anybody else thinks or says. I didn’t understand the yellow rose last time. I want this, Josh, I want this. I didn’t recognize it before.”

Josh’s elation and the intimacy of the moment was shattered by a stocky figure who rose from a distant table and approached. “What do you think you are doing here?”

“What are you doing here, Brian?” Faith’s voice was tremulous.

“Now I understand,” Brian announced to the entire restaurant. “This street runs two ways. Now we see why I don’t have chlamydia.” All eyes were turning. “I can’t believe this.”

Josh stood and offered to shake Brian’s hand, squeezing between Brian and Faith. Brian backed a step, withholding his hand.

“I suppose he has a key to our apartment,” his disgust spattering into Josh’s face. “I borrowed a truck. I want to come get my desk, chair, and bookshelf.”

“I told you, not the bookshelf.”

“Actually, I do not have a key to her apartment,” Josh said.

Brian remained indignant. “I suppose you have slept in my bed?”

“Actually, no.”

“I suppose you have screwed my wife!”

“Actually, no.”

Faith said, “It’s really none of your business anymore, Brian. You signed papers, remember?”

The food arrived and Josh sat back down, the three words blinding him.

“If you’ll give me a key, I’ll go get my things,” Brian hissed, holding out his hand. “I need to get Peter’s truck back.”

“You’re not going in my apartment without me,” Faith said. “How about Thursday night. That’s the next night I’m at home.”

“How about now,” Brian insisted. “I need to get a move on.”

Faith looked at her watch. “Eight thirty?”

Brian exuded contempt. “Whatever.” He walked straight for the door.

Faith and Josh both took a deep breath. Julio had approached, attracted to the noisy situation.

“Is everything fine?” Julio almost whispered.

“It will be,” Josh said. “We’ve got it under control.”

Faith reached over and took Josh’s hand, “Can you come with me?”

“Absolutely. You shouldn’t do this alone. He scares me a little.”

“He’s getting worse,” she said.

“I wonder if there are other things going on in his life. Maybe the chlamydia woman is making life difficult.”

“I don’t know,” she said. “What’s more, I don’t care. Isn’t that awful?”

“No, I don’t think so. His problems are his problems. We face ours, we make our lives happen, we deal with our issues. He has to deal with his. It is up to him to pick up the pieces and make something of his life.”

He watched her wipe a tear, then, “I’m sure you deserve better than that.”

“I’m so sorry,” Faith whispered. With romance and appetites quashed, they took their food to go.

Eight thirty came in a flash. With Josh on the barstool at the kitchen counter, Faith answered the door. Brian barged in with a hand truck. He rolled the drawer-less desk on its end and wriggled the hand truck under it. “Are you going to help?”

Josh jumped down off the barstool.

“No. It’s your desk,” Faith said. “Help yourself.”

Josh slinked back up on his perch, assumed his carrion-eating raptor posture and clawed to contain a cantankerous grin.

Brian made several trips to the truck, taking decorations, his desk, one of the living room chairs, the dining room set, and a dresser. When he returned with the hand truck, short of breath and sweaty, he demanded, “Get your stuff off the bookshelf so I can move it!”

“No,” Faith snapped. “We had that discussion. I bought it. I keep it. This is your last trip here. Be sure you have everything that’s yours. Whatever you leave tonight is mine.”

“You’re such a pain!” With that, he turned and exited. Faith slammed the door behind him.

“Don’t let the door hit you,” she said, too late for him to hear.

Josh was bursting to ask, “Did you say he signed?”

“Yes. Then I sent it to Marla to check over and file.”

“You were assertive tonight, I was impressed. I like that in you.”

“I hate it. I always feel like I’m a bully, or bossy, or a nag.”

“I haven’t seen that at all,” he said.

“You were going to help him!”

“I’m sorry. It was a reflex,” he said. “I don’t have the pent-up frustration and resentment you have for him. I thought the quicker he’s out of here, the better. But I sure enjoyed watching him struggle.”

“I’m glad this is coming to an end,” she said. “It has been a nightmare. He has become such an obstinate twit.”

“I have not known him long, and only at work. From that I would say obstinate is mild. I wonder if there is pressure at work. I know Ann can’t stand him, and poor Haley dreads him. Maybe someone has talked to Emily.”

“Do you really think so?” she said. “I hope I had nothing to do with that. I hope you are wrong about something else going on in his life. I wouldn’t want to have made that happen.”

“Wait. You didn’t. The nastiness between Ann and him is all his doing. Haley is all his doing. You didn’t do any of that. He made his bed, so he needs to sleep in it. Like I said, he needs to pick up the pieces and get his life together. Only he can do that.”

She made a lamentous face. “Haley was making fun of him at the charting station a few days ago when I walked up, and then she shut up. I told her it was hilarious and to keep going. You should hear her repeat some of the things he has said to Ann. It’s not nice to make fun of someone behind their back, but I didn’t tell her about any of the things she recounted. She must have found them out all on her own. By that I mean Brian did it for himself. I enjoyed it.”

“That’s what I mean,” Josh said. “It’s his doing. He needs to make his life happen. I saw him come out of the little conference room a few days ago with Haley and Ann. Haley’s face was beet red, and, of course, you would never be able to tell if Ann’s face was red.”

Faith walked over and kissed him. For Josh, it was an earth-shattering, mind-boggling moment. A miracle had happened. He grabbed her, pulling her close. She made the romantic instant intense.

She walked around the living room tidying up, adjusting some of the scant furniture to cover up the obvious absence of Brian’s desk, a chair, and a lamp. She performed her landing on the couch with legs under her, a smooth, practiced movement.

“Your dining room looks lonely,” Josh said.

“And the only things in the bedroom are the bed and a nightstand.”

“It’s all you need. It’s comfy. You still have your couch.”

He found the bag with the take-out food, used the microwave to rejuvenate it, and put it on plates. “I’m starving,” he said.

They sat on the couch in silence, eating, mostly in silence. Near the end of the food, she said, “I love you.”

“What?”

“I love you.”

“I love you too.” They kissed again.

She walked him out to his car, hand in hand, where she got in the passenger seat, confusing him. Did she want to go somewhere?

“I’m afraid I’m going to have to move,” she said. “I can no longer afford this place. Brian stopped paying and the rental company found a new tenant. I have to be out by the thirty-first. I didn’t get a single phone call from the University’s residential services listing. Haley doesn’t want me.”

“No. She wants Ricky. Is there any way I can help? It’s only two weeks away.” A question was straining to jump off his tongue.

“I don’t think so. I’m tired.” She looked at him, then leaned over and kissed him.

He held her by her shoulder and pressed into her. She put her hand on his cheek.

They gently parted. She sniffed. “What’s the tear about?” he whispered.

“Happy, sad, tired, and I had two liters of beer.”

“OK.” He lost the restraining battle with his tongue, “Move in with me.”

She leaned away just a bit, opened her eyes wide, and tilted her head.

“You don’t have to. Just an idea. I think you are cool, and I want you in my life. I’ve loved you for a long time.” He reached over and pulled the rose from its parking place in the vent near the passenger door. “Here. Peace.”

Another tear.

“I know it’s fast,” he said. “For me it’s not fast because I thought you were beautiful when I met you at orientation and I’ve been watching and waiting ever since. I was brokenhearted when I found out you were married, then the divorce seemed like a miracle. For you, I know it’s like a first kiss tonight and move in tomorrow. But you don’t have to accept. Just think about it.”

“I know you have been working on it. I don’t know why I didn’t see it. You’ve been a good friend, you’re a compassionate doctor, and enjoyable company.” She wiped mascara. “I want to move in with you. I’m just really nervous.”

“Think about it. Take your time.”

She whispered, “I don’t have much time.” She leaned over and kissed him again. They slowly parted, and Josh blurted, “Oh, god, there’s Haley!”

Faith’s head snapped around to look out the passenger window in the direction that Josh was looking. No Haley.

“You’re mean!” she yelled, punching him in the arm. “See you tomorrow,” she said and slipped out the door.

“What’s up Josh,” Ricky answered. “Another two liters of beer?”

“Well, yeah. But I just wanted to run something by you. Do you think Faith is abused?”

“I have wondered that, but I don’t know her well enough. Considering who she is married to, I wouldn’t be surprised.”

“I don’t think she’s married to him anymore. My sister Marla gave her papers for a non-contested divorce which he signed, and she sent back for Marla to file.”

“Is that true?”

“Yeah. I called Marla the night we were at Padilla’s, you know, when Haley asked about a divorce. How did she know, anyway?”

Ricky snickered. “I think it was a good guess. I don’t know how else she would know about something that hadn’t even been seriously contemplated before that.”

“Anyway, she keeps worrying about whether she is the reason she is getting a divorce and worries that ‘dragging’ him to Albuquerque is the problem. That sounds like a battered spouse to me.”

“Did you ask her?” Ricky asked. “I would ask her.”

“I asked her if he ever hit her, and she said no. But I am thinking the abuse is more psychological.” Josh took a deep breath and waited for Ricky who didn’t say anything. “When I got her the divorce papers, she was startled, and I think she thought I expected her to divorce him. It’s not that I didn’t want to, but I told her they empowered her and that it was up to her what happened next and when. She seemed surprised. I think Brian is controlling.”

“No joke!” Ricky said.

“What do you mean?”

“He’s controlling of us. We can’t make any decisions or treat any patient without talking to him. It’s smothering how he hovers over us.”

Josh nodded, even though Ricky couldn’t see. “That’s true.”

“Well, treat her better, and you will catch her. Remember, a boy chases a girl until she catches him. I’m thinking you are totally hooked. I just have to wait for her to reel you in.”

“I asked her to move in with me.”

“What? Really?”

“Yeah. She can’t afford her apartment now that Brian has moved out. She hasn’t been able to find another roommate, and I don’t think cheap apartments are plentiful on the north side of Albuquerque.”

“I would agree with that.”

“She says Haley doesn’t want her, which I took to mean she wants you.”

“Someday.”

“So, I asked her. I think she accepted.”

“Good job, Josh. She’s reeling you in. Just don’t fall off the hook.”

Chapter 14

The glass in the door rattled.

“Brian, what’s up?”

“Did you have anything to do with my wife divorcing me?”

“No! I didn’t know you were getting a divorce.”

“Josh Menkowicz apparently is helping my wife divorce me. He has a lawyer sister where he got divorce papers that they coerced me into signing. They filed them, so I guess now I am divorced. He has successfully stolen my wife, and I thought you probably were behind it.”

“No.” Peggy said. “But how did they coerce you?”

“Faith told me to sign, or else.”

“Or else what?”

“I don’t know. She just has a way of ordering me to do things.”

“Don’t you have any control?”

“I don’t feel like it.”

Peggy shook his head. “That’s a shame.”

“Are you being sarcastic? Did you want to be behind it?”

“No. I never like when marriages fail. But signing indicates you consent. Now you’re telling me you didn’t consent. Which is it?”

“There is no point in me refusing. It would only incite more action in which I would wind up divorced anyway, and probably with a mountain of lawyer bills and alimony to boot.”

“What effort did you make to reconcile?” Peggy asked. “Did you go talk to her?”

“Yes. She refused to let me move back in.”

“It might take a lot of conversations and perhaps a marriage professional to get to that point.”

“And time and money. More than that, she has you and Josh on her side.”

“I’m not involved in this one way or another,” Peggy said. “I had nothing to do with it. I wasn’t even aware it was happening.”

“Faith and Josh don’t talk to you?”

“No. Sometimes about patients after rounds. It sounds like you could have made a more diplomatic effort.”

“I don’t think it’s worth it. I don’t think any of this is worth it.”

“What isn’t worth it?” Peggy asked.

“It’s so hard.”

“Anything worth having is hard. Are you telling me that a marriage is not worth having?”

“No. I’m saying I am in a position that I don’t have any choices. Faith and Josh have cornered me and forced this to happen. I don’t know why we couldn’t go on as we were.”

“Can you honestly say that from Faith’s perspective?”

“Yes. She just blasts her way through life and gets what she wants, when she wants it. And now she wants Josh.”

“Is she running toward Josh or away from you?”

“Toward Josh.” He made his chair squeak and clatter. “This is so hard.”

“But look what you have accomplished. College, medical school, residency, fellowship, and now practice. Hard is not a stranger to you.”

“I didn’t know life was going to be like this.”

“Excuse me? Did anyone ever say life was going to be easy?”

“I don’t suppose they did.”

“It won’t be. If you do your whole job and do it well, it will consume you. It will take time, discipline, money, and effort. Then if you groom a marriage and raise a family, it will consume another you. It will take more time, more money, and more effort. There will be turbulence where career meets family. But when you get to my age, you will be rich, just not in dollars.”

“But how does this license someone to steal my wife?”

“It doesn’t, and I didn’t, and I suspect neither did anyone else. It would be ignorant to think Faith Pernitelli could be swayed into making a life-changing decision she doesn’t want. That woman knows what she wants, gets what she wants, and is willing to spare no effort to accomplish what she wants. If it’s not too late, you might want to get yourself together and make things happen instead of letting things happen to you.”

“You know, you are a crazy, annoying old woman,” Brian said standing. “I don’t know why you are inflicted on us.”

“That’s for you to work out in your head. I would suggest you get on it and get it done. Remember, you came in this room under your own power. I didn’t drag you here.”

“Do you honestly think I am along for the ride? I’m not. I am in total control of life.” Brian sat back down.

Peggy returned her brain to the upright position from Brian’s one-eighty, took a pull on a Diet Mountain Dew, and said, “By what actions would I know that was true.”

Brian’s inflection subdued, “I make rounds every morning on time, I see all the patients in the clinic that they assign me, and I am available to anyone who wants to call me for something.”

“Those are just the basics,” Peggy said. “Where’s the extra, the bonus, the prize?”

“You are an annoying old woman.”

“My wife agrees.”

Brian got up and left, closing the door so gently the window didn’t rattle.

Chapter 15

The tram door opened, and Josh and Faith picked a seat facing the dust bowl, a geologic basin that contained Albuquerque and several surrounding communities. It was early morning, the air was crisp and dry, and the visibility unlimited. Josh had seen an offer on TV for tickets and had made the call to get them.

“I have heard about this ride, and I have always wanted to do it,” Faith said, nestling against Josh to allow for more people to be seated. “This is a perfect day.”

It only took minutes to load the tram, close the door, announce the safety instructions, and they were off. The wheels emitted a soft hum and the desert floor fell away. The mountains to the north became much taller than they had looked at the station, and the mountains to the south came into view over the horizon. Sharp faces of granite formed long shadows in the morning sun, the station at the bottom of the tram disappearing as they floated over the first ridge. For a short time, the summit of Sandia Peak disappeared. Some wild goats were visible in one of the crevices to the south.

“This is really beautiful,” Faith said, craning to see all vistas along the way.

“It sure is,” Josh said. “Look, there’s even some snow.”

Emerging from the tram, the cold air was shocking. Josh zipped up his coat and pulled on a stocking cap. “Boy, it’s cold up here.”

“Yes,” Faith said, buttoning her coat and pulling up her hood. Following the decking to the south, Faith was fixed on the mountains to the south. “I wonder how far you can see. Hundreds of miles, I bet.”

“I’m sure,” he said. “It’s amazingly clear.”

Together, hand in hand, they walked to the south end of the deck. From there, they identified some landmarks in Albuquerque, looked at a map poster showing Rio Rancho just beyond Albuquerque, the Jefferson Mountains in the distance to the south, and out over the Navajo Nation to the west. “We are five thousand feet above Albuquerque, it’s no wonder is it so cold here,” Josh said.

“We need to explore some of this state when we get some time off,” she said. “Just listening to Angie talk about Shiprock and the Monument Park area, what I’ve read of White Sands and the Carlsbad Caverns, there is a lot to see.”

“You know those are all a long way from here,” Josh said. “This state is enormous. Carlsbad is a four-and-a-half-hour drive. Shiprock’s almost four.”

“Yeah. Remember Betsy? She was from Farmington and said it was three hours, and Shiprock is beyond that. But it would be fun anyway. We haven’t even been to Santa Fe and that’s only an hour.”

They moved toward the gift shop and found a map of the hiking trails atop the peak. “Do you want to explore one of these?” he asked.

“Of course. Let’s go.” She started toward one of the wider trails leading toward Sandia Crest, apparently uninterested in planning by map.

“Hey, wait!” he shouted when he noticed she was a hundred yards away. He ran to catch up.

“It’s nice up here,” she said, marching along bobbing her head from right to left. “I wonder if that’s Santa Fe,” she said and pointed to a developed area against the mountains to the northeast.

“I imagine. I don’t think there are any other cities in that direction.” He picked up a large pinecone and handed it to her.

She looked at it in her hand. “This is huge,” she said. “You could play softball with this,” and pitched it at him.

He caught it in his hand, looked at it again, and threw in back in the general area where he had found it. For a distance, the pine needles crunched under their feet, the snow squeaked, and the gravel growled its opinion. Birds flitted around from tree to tree, the sun blinked between tree trunks, and the shadows of branches played tag along the trail.

In a few more minutes, she was out against the edge of the ridge looking down into the canyon, thousands of feet below. “This is amazing,” she said. “Look, you can see the trail go all the way around the canyon and disappear at the bottom. Is that the trail you take if you want to walk down?”

“I think so,” he said. “We should try that, but maybe in the summer.”

“Good idea.”

At this point the trail had narrowed, and there was snow on both sides, especially under the trees. She picked up a ball of snow and threw it at Josh, completely missing. He retaliated. The ensuing snowball fight lasted until they were in each other’s arms. After a kiss, they resumed their stroll.

Josh wandered out onto a large bare granite outcropping, painted with lichen, patched with snow, and fully in the sun. A marmot poked its head up to check them out, then scurried off out of view. From that vantage point, the Sangre de Cristo mountains to the north came into better view, completely snow-capped, bright on the sunny slopes, and nearly black on the shaded ones. Cars could be seen glinting in the sun in the distance. The Douglass Firs whispered their soothing words and waved their branches in the breeze.

“They don’t have this in Oklahoma,” Josh said.

“West Texas doesn’t look like this either,” she said. “Aren’t these trees cool? They make a really nice sound. Look, there’s another one of those ground hog things.”

“I bet there are no marmots in Texas.”

“Ground hogs,” she said, as one of them whistled. “We have ground hogs. They aren’t anywhere near that big.”

In half an hour, they arrived at another outcropping that had a little stone building with openings for a door and windows. “I wonder what this was?” she asked.

“The sign says it was a lookout first, and later a shelter when the tram was built.”

On a stone bench, she sat, pulled the hood of her coat up, and tied it around her face. “Is there anywhere in New Mexico where there isn’t wind?”

“I don’t think so. I’ll bet there is wind in West Texas,” he said.

“You’ve got that right. Sometimes hot air,” she snickered.

“Yeah. We have so much wind we have wind farms,” he said.

“And Texas Tech in Lubbock has a wind energy engineering division.”

They sat for part of an hour taking in the scenery. He was holding her hand, fingers interlaced, inside the pocket of her coat. Except for the breeze in the trees, it was quiet, something they rarely got to enjoy. She launched a rock over the edge, and watched it bounce, in apparent slow motion, on its way to a new resting place. A bird landed in front of her, looked her square in the eye, and then flitted away.

“How peaceful this is,” she said. “But I’m sure glad you had us bring our coats. I would not have guessed at how much colder it would be up here.”

“The air is fresh and clean, isn’t it?” he said. “I’m really glad we did this.”

Another trail took them back to the tram station, giving them a view of the ski area and the eastern slope of Sandia Peak. Skiers were enjoying the sunshine. A chipmunk chattered at them on the way to the giftshop. Inside, they looked at books, pottery, and Faith bought a stocking cap.

As she was checking out, the tram appeared over the ridge on its way up. They made their way to the loading platform and were ushered onto the last seats, facing uphill. In the warmth of the tram, she put her hood down, pushed her hair behind her ears, and was looking around at all the scenery, but Josh could hardly take his eyes off her. As their trip started down, the sun shown in Faith’s face, and Josh was stricken by the dark brown of her eyes, her freckles, and the sparkles of light from her hair. He wasn’t sure which was the better scenery. New Mexico was beautiful, all right, but…

One of the visitors saw a wolf and was pointing, but Josh couldn’t see it. The change in temperature impressed them as the tram rumbled and clattered into its landing. Holding tight to her, they exited, descended the stairs, and headed for the parking lot. By this time, it was the middle of the afternoon.

“I’m starving,” she said.

They found an ancient diner several miles from the tram station and decided to give it a try. Old fashioned hand pressed burgers with cheese in buns with hand cut potato fries adorned a tiny table. They fed each other fries, made funny faces out of pickles, and shared a hand-dipped chocolate shake.

It was almost dark when they finally arrived home. “That was the most fun day I have ever had in Albuquerque,” she said. “Thanks for taking me. Thanks for finding the ad on TV.”

“I have never done anything like that. We will have to do it again.”

“I hope we do. Maybe we can hike all the way back down. It sounds like fun, but it would have to be summer.”

“We can do other things in New Mexico, too,” he said. “There are lots of things to do. Our problem is we don’t have much time off, and some of our time off has laundry, groceries, and sleeping in it.”

“We’ll get to some of it even if we have to use some vacation time.”

“I love you.”

“I love you.”

Chapter 16

It had been a heavy Friday for the first-year residents. Changed into street clothes, Josh made a quick stop at the charting station, having thought of something he had forgotten to order on one of the patients. He entered the minor detail in the computer and logged off. Ann plunked in the seat beside him.

“Thank God it’s Friday,” she said.

“I agree with that,” Josh agreed.

“But you’re on call tomorrow. So, Friday doesn’t mean that much to you.”

“It’s the end of the week. There’re never office hours on Saturday, so the workday isn’t quite as frantic, and then there’s Sunday to recover. Tonight, home is just waiting for me to crash and burn, more of a mind thing.” He wanted to change the subject. “Can I ask you a question?”

“Sure,” she said.

“What do you think of Brian Yankton? It seems like you guys are at odds.”

“I don’t know. He is hard to deal with. We need to take care of patients, manage easy things on our own, and be proactive in teaching.”

“I don’t think he will ever be any of those,” Josh said, “do you think? It seems like he is completely mechanical. Either that or he is so intelligent that he can’t relate to us.”

“It’s sure not that,” she said. “He is academically weak. Several times he has given false answers to questions, and not all he says is logical. It would be better if he said he didn’t know, and then came the next day with a real answer.”

“That’s how you, Peggy, and Emily are. We all appreciate that. No one can know everything.”

“I agree.” She looked him straight in the eye. “There has to be an honest, pure relationship. There can’t be any smoke and mirrors. In our business, smoke and mirrors clouds judgement and derails success.”

Josh nodded.

She went on, “Don’t you think saying you don’t know takes some knowledge and self-confidence? It takes some command of yourself. It also takes self-confidence to say you were wrong. We all get things wrong sometimes.”

“So, you think he’s not self-confident?”

“Yes, mostly.” Ann was staring at a computer screen, briefly distracted. Josh looked at her face thinking she was someone he wanted to model, someone who would make an impact on his professional life, and who had made a life for herself, on her own, and that she owned it.

“Where are you from, Ann?” Josh asked.

“Detroit. I was raised by a single mom who worked two jobs so my sister and I could go to school. We were doing homework when our friends were running around in the streets playing softball and soccer. But she taught us honesty, self-confidence, the importance of admitting a mistake, and how crucial taking control of your own life is. How your life turns out has to do with what you make of it. The world is not responsible for your own mistakes or failures.”

“I think I was taught those things also. But in addition, my mother insisted that we shouldn’t try to control anyone else,” Josh said. “There might be times to offer an opinion or a suggestion, but no friendship or marriage can tolerate dominance.”

Ann stood. “I think I agree. I’ll see you tomorrow.”

Standing to go, he saw Faith come out of the locker room and head for the elevators.

“Dinner somewhere?” Josh turned to catch Ann. “Do you want to go with us?”

“No,” she said with a smirk. “Thanks, though. A certain urologist is fixing dinner.”

“Kidney stew?” Josh couldn’t resist a urology reference.

Ann rolled her eyes, acknowledging she got the joke. “Prime rib. See you tomorrow.”

Faith let Ann distance, then turned to Josh, “I’m famished, I’m exhausted, and I’m on call Sunday.”

“Me too. I’m on call tomorrow.”

“Where?” she asked.

“Here, dork. Where else do we take call?” He started laughing.

“No, smarty. Where do you want to eat?”

“Subway?”

“Not!” she snipped, to his delight. “That’s just downstairs. I want to sit down, and they bring it to me.”

“How about Longhorn Steakhouse near my house?”

“Ooo! That would be good,” she mumbled. “I like a good steak.”

In the elevator he said, “I figured.” In a robot’s voice he said, “You are Texan. Texans like steak. You like steak.”

She snickered. “Correct.”

“Are you riding with me and I bring you back? Or are you driving yourself, and I go home from there?”

The elevator door opened, and they headed for the parking lot.

“Ride with you.”

“Do you want to stay with me tonight?” he said. “I want beer.”

Josh led to his car, flicked the unlock button, and she entered the passenger side like she had done it a hundred times.

“Where’s your car?” he asked.

“Home. I walked over yesterday morning. It was nice out.” He saw the expression on her face announce a change of subject. “Can we stop by my place?”

“OK. Any special reason?”

“I need a couple things if I’m staying over.” The acceptance rumbled over him like a freight train. He had extended the invitation almost rhetorically, never thinking she would accept. He was still not catching the indirect way she had of saying “yes.”

She was quickly in and out of her duplex, but it was still late enough that evening I-40 evening rush traffic had calmed, depositing them at Louisiana Boulevard in short order. A few blocks north, he pulled into the parking lot at Longhorn Steakhouse.

“I’m starving,” she said. After a short wait, they got a table. “What do you get here?”

“Flo’s Filet, rare.” He didn’t even have to think.

She scanned the menu. The server came, and they ordered.

“A rare steak?” she questioned.

“It’s so good. Almost as good as Oklahoma Angus beef.”

“Oklahoma. Is that in the United States?” she asked.

“Yes. Texans need a passport to go there.”

She stuck her tongue out.

“What are you going to do after you finish your residency?” he asked.

“Maternal-fetal medicine,” she said. He thought she was kidding. “No, really. I like fetuses. And I like delving into the medical problems that some of our pregnant moms have.”

“That’s good. Where do you want to go for that?”

“Dallas, maybe,” she answered. “It’s a dream. I didn’t get into the Texas Southwest Ob-Gyn program, and it would be wonderful to fellowship there. Or maybe San Antonio.”

“San Antonio is an amazing place. It has several major maternal-fetal medicine training programs and so much to do. I love the Mercado and their zoo.”

She threw the question right back. “What do you want to do?”

“I don’t know. Cancer always fascinated me, and I liked my gynecologic oncology rotation as a medical student. But the rotation here was awful. I don’t want to manage abnormal pap smears all my life. Vulvar cancer is disgusting.”

“Ugh,” she said, “that’s no joke.”

“Maternal-fetal medicine is good. Maybe just practice general ob-gyn and do what is needed, like Peggy.”

“She’s a good role model,” she said, “but I don’t think our generation will let you do all of the things she did, like amniocentesis, advanced ultrasound, lupus, and diabetes. Kind of like your grandfather.”

“I could always do a fellowship after I’ve been out and am done with my boards. Maybe then I would have a clearer vision of what I wanted or what the community I live in needs.”

The food came. “I invited Ann,” he said, “but I should have included her husband. I don’t even know his name.”

She snickered, “Ask Haley. She’s right over there.” She looked to the table across from them.

His head pivoted like an owl’s. “Not,” he retorted.

“I don’t know his name. If she told me, I forgot.” She took a bite. “You said Haley wants Ricky to join her in her apartment. Why don’t they do it?”

“Ricky said they are taking it slow. They are both busy.”

“So are we.”

“But I don’t get the sense that he is totally smitten like I am.”

“Josh. Really?”

“Yes. I just love you. I couldn’t wait like they are. Maybe they are not as sure as I am.”

“What about me?” she asked. “How did you know I don’t want to go slow?”

“Do you?”

“No.”

“Whew. I thought you might say yes. I don’t want to go slow.”

She looked up to make eye contact and said, “Doesn’t Brian scare you?”

“A little,” he said. “There is something going on there that is beyond what we know. Or what I know, at least. It is hard to believe that it’s all just his nature.”

“It is a little. He always was fiery. I think he’s a lot more now than he was before.”

“He was scary in the restaurant.”

“Yeah,” she said, taking another bite, but not sounding as though scary was at the top of her list. “He’s getting worse.”

“You told me about Haley making fun of him. A week ago, or so, he chewed Haley for being ignorant about coronavirus. We all are ignorant about coronavirus. It will be years before we are not. I thought it was unfair.”

“I just avoid him. I don’t want to engage him because I would just fly off the handle and talk about things no one needs to know about.”

“Like chlamydia?”

“Yeah, and there are other things” she smiled. “Can you imagine what Haley would do with that?”

“I think it would serve him right.”

The bill came. Josh put a credit card in the folder and handed it back so quickly Faith had no time for reaction or discussion.

“You don’t have to pay for this.”

“Yes, I do. I’m dating you.”

“I can’t date, I’m married — no I’m not.” They laughed.

Josh’s car took them to his apartment. He opened the door and wandered back to the second bedroom encouraging her to follow. “What’s this?”

“My grandfather’s roll-top desk.” He was digging in little cubbies.

“Tell me about him,” she said.

“He died about ten years ago. He was quite a bit older than my grandmother and was in the second world war.”

“What did he do during the war? Was he a doctor?”

“Yes.”

She looked at Josh deeply, “That was a short answer.”

“He was born in 1914, went to medical school in Dallas, then came back to Clinton for a few years. He took time out for the war, and I don’t know anything about what he did, but I do know that he was quite skilled at trauma after returning to Clinton. Putting those things together, I bet he was in it up to his elbows.”

“Many people in that generation didn’t talk about the war.”

“My grandfather sure didn’t.”

She ran her fingers over the smooth finish. “It’s so elegant. It is also of dark wood, which is sort of out of style now.”

“Yes. He got it when he got back to Clinton after medical school. He knew the man that built it, but I didn’t.”

“Someone in Clinton?”

“Yes. I don’t know who it was or anything about him. My dad doesn’t even remember him.”

“I can’t believe how many tiny drawers and cubbyholes it has. The little drawers even still work.”

“Some of that is me. I did replace some of the metal drawer runners in the big drawers, and I keep the wooden runners of the little drawers soaped up.”

“Soaped?”

“Yes. That’s how you keep them sliding smoothly, according to my grandfather.”

She put her arm through his, “Keep it.”

“Oh, yes,” he said. “I’m not going to let it out of my sight.” He reached in one of the cubbies and handed her a key.

“What’s this?”

“Oh, duh. It’s the key to this apartment.”

“I didn’t accept yet,” she said.

“Yes, you did. And I’m so happy I can hardly stand it.” He was getting confident in reading her affirmative answers obscured deep in indirect verbiage.

“I’m going to the bathroom,” she said, grabbing a little gym bag.

Josh took off his shoes and found some more beer in the refrigerator. He poured it into a pair of mugs she had gotten at the birthday party and placed them on the little table between the wing chairs. It was all he could do not to chug one, but she came back out in a sheer nightie and sat on his lap. He kissed her. She turned, putting her knees alongside his hips against the chair’s arms, facing him up close. He kissed her again, then explored her with his hands. She requited by pressing her breast into his face.

“I think I should go to the bathroom now,” he said, lifting her to the floor and fleeing. There, he changed into his usual night wear of shorts and a t-shirt. When he arrived back in the living room, she was gone. A squeaky giggle came from the bedroom. He joined her, holding her tight in his arms. So much for going slow, he thought.

Josh awoke to find Faith’s head on his shoulder, his arm numb, and his back stiff from a hard night’s sleep. He gently stroked the velvet skin of her naked back.

“Good morning,” he whispered. “I love you.”

Faith blinked her eyes trying to clear the Sandman away. He held her tight.

“I’ve got to go to work,” he reminded her, a message he knew she didn’t want to hear.

“I know. I just want to lay here. I don’t feel like going to work today.”

“You don’t have to. It’s Saturday, and you’re on call tomorrow,” he said, slithering out of the bed.

“If you’ll take your shower, I’ll fix coffee,” she said.

Showered and dressed, he headed to the kitchen where the aroma was tantalizing. Dressed in a terry cloth robe, she had made scrambled eggs with cheese, put them in a tortilla, and arranged them on plates. He smiled at the presentation. “Yum.”

She turned around and hugged him again. “How do I get home?”

“Go with me now? Or go back to bed and take Uber.”

“Back to bed and take Uber.”

“OK. Remember to take your key.”

He kissed her once more, gathered his things, and pushed himself out the door.

Sunday came fast enough. They both were at rounds but deliberately didn’t stand together. Haley was not to be outdone. “Faith, what’s with you, girl?”

“What do you mean?”

“You have pep in your step and a grin on your face. Did something happen?” Typical Haley.

Josh knew it would kill her not to know, and savored Faith’s skillful deflection, “I don’t know what you mean, Haley. Nothing happened. It was Saturday. I guess it was the beer.”

The contest was on. Josh wondered how long it would take Haley to find out, and how she would go about unearthing it.

Monday night found the two of them exhausted and on the couch. Reading was impossible, conversation dragged, and the television was boring. Before he recognized it, Faith had made a call and put her phone on speaker.

“Hi, Mom,” Faith greeted. “How’s everybody?”

Marianna’s gleeful voice danced over the phone, “Fine. Everybody is fine. How are you? Natalie says you might move.”

“Yes, Mom,” she replied. “I can’t find a roommate, the leasing company has found a new tenant, and I have to be out by the thirty-first. I will need you guys to help me move.”

“But what about the boy you are going to room with? We haven’t met him.”

Faith giggled. “He’s right here, Mom.”

“Ms Pernitelli, I’m Josh.”

“Oh, nice to meet you Josh. Please call me Marianna. I’m sorry, Jim isn’t here. He would want to meet you too.”

“He’ll have a chance,” Faith said.

“I am sorry about Brian, honey.” Marianna was still recovering from the break-up, while Faith and Natalie had more than moved on.

“It’s for the best. We weren’t getting along the greatest anyway. He was such a butt about some things. No, he was a butt about most things.”

“I’m still sorry,” she echoed. “It’s sad.”

Faith confided, “It’s a failure. That’s the part I am having trouble with.”

“I don’t think she failed,” Josh said. “She can’t control what Brian does.”

“I agree with that,” Natalie said.

“Aren’t you afraid you are jumping the gun on moving in with another man?” her mom inquired.

“It is sudden, Mom,” Faith said, “But he’s a real gentleman, and he’s been treating me so nicely since July. It was two weeks ago that Natalie made me realize how good he was, and what his intention was. I don’t want this one to get away. I am excited to see what you guys think.”

“Does he have his own place now?” she asked.

“Yes, Mom. He’s neat, tidy, and organized. Both at work and at home.”

“How big is his place? Is it big enough for two?”

“It is bigger than the place I had with Brian. And in better condition, too. There will be a little longer drive to work, but it won’t take much more time to get there, since it’s mostly interstate.”

“Tell me some more,” Marianna invited. “Does he cook? Does he iron? Is he a good doctor?”

“Jeez, Mom. How come you didn’t ask me all these questions about Brian?” Faith chuckled.

“I guess because, for us, this is a sudden development. Besides, I thought I did ask you about Brian.”

Faith’s voice was bubbly. “He cooks, he irons, and he is becoming an excellent doctor. I hope I am becoming one too.”

“Your voice is so happy, Faith,” Marianna observed. “I don’t remember you talking about Brian this way.”

“I don’t know if I ever felt this way about Brian. Josh is so different!”

“Different?” she questioned.

“Different from Brian. Brian was all business and no play. Josh is serious about medicine, but he likes to talk about food, life, Albuquerque, and friends. The conversations are more diverse and more interesting. He teases me without being mean.”

“Where is he from?”

“I’m from Oklahoma, Marianna,” Josh said. “Clinton is on I-40 about halfway from Oklahoma City to Amarillo.”

Faith said, “I don’t know that area well. I don’t even know the Texas panhandle well.”

“No, I don’t either.” Marianna said.

“Josh says that Oklahoma is in the United States. Texans don’t know that because they live in a whole other country.” Faith chuckled again, enjoying her image of Josh’s face telling the joke.

Marianna giggled along with Faith. The pleasure was infectious. “Tell me about his family.”

“Well,” Josh said, “my dad’s a dentist, my mom’s a nurse, and my sister’s a lawyer and lives in Amarillo. She was the one that gave Faith the divorce form to fill in and get signed. She even reviewed it and filed it for her.”

“Isn’t that nice?” Marianna complemented. “Did she charge you?”

“No, she said it was for free if I married Josh. Otherwise, it was a hundred dollars.”

Marianna gasped, “Does that mean you are obligated to Josh, Faith?”

“No, Mom. It’s a joke. She is full of jokes and humor, like Josh. I think she was picking on Josh because she hasn’t liked any of his girlfriends. She seems smart and nice. It’s cute how she calls him Joshua.”

Marianna giggled some more. “Have you met them?”

“No,” Faith said, “only on the phone.”

“I see.”

“Next Saturday would be a good moving day for us. Both Josh and I are off.”

“I’ll talk to your Dad. I know Natalie is off, and she is giggly wiggly to meet Josh. Did she talk to him on the phone?”

“Giggly wiggly, Mom? You used to talk about us that way when we were kids.”

“That’s how she’s acting.”

“I have talked to him, Mom.” Natalie said. “He’s fun and treats me like a sister, but not like a kid.”

“Well, she’s excited about Josh,” Marianna repeated.

“Yeah, I am.”

“Well, I’ll see you in a week or so.” Faith let the call go.

Chapter 17

“Summarizing,” Ricky said, starting morning teaching rounds, “we have three asthmatics, one of which might have a viral illness, two of which might be spring asthma exacerbations.”

“Did anyone consider coronavirus?” Haley asked.

Ann said, “To date, we’ve had no identified cases in New Mexico. The southern border does worry me, but so does air travel in our society. I don’t think there has been widespread testing in New Mexico. Am I right, Peggy?”

“Yes, correct — I think. What is our testing availability here, now?” he asked.

“I don’t know,” Ann confessed. “The CDC website says to contact your local health department, but my experience with them has been both limited and negative. I haven’t talked to them recently.”

“How about if I do that today since I have more free time than you guys? Do we want our febrile patient tested? She fits the CDC guidelines.” Peggy took a breath.

“Wait a minute,” Brian said. “Why do we think she has coronavirus?”

“I don’t know if we do,” Haley answered. “But if she does, there are serious implications for us, other patients, and her family. Since she has a febrile illness and her influenza and strep screens are negative, it remains a possibility.”

“So, what about the other two patients?” Brian asked.

Haley hesitated, then, “Neither of them is febrile. Mostly those are just asthma attacks without other symptoms.”

“How are we treating them?” Brian asked.

Faith had made rounds on them, so she felt compelled to insert the details. “They are getting steroids, bronchodilators, and azithromycin.”

“What bronchodilators?” Brian asked.

“Albuterol and theophylline.”

Brian stiffened, “We should not be using theophylline. That drug is a thing of the past. I think we should stop it.”

“So that tomorrow’s attending can restart it?” Faith asked. “Ann and Peggy, help me here.”

“I started it yesterday,” Peggy said. “It makes sense not to discontinue it.”

“It seems to work well,” Ann said. “I have used it in the office on a couple of patients who were having trouble with inhaled steroids and it seems to smooth their treatment and symptoms.”

“Whatever. Let’s move on with rounds,” Brian said.

“If she has coronavirus,” Ricky said, “we’ve exposed numerous health care workers and visitors. She’s had quite an army of visitors, including her troop of children. Once the influenza and strep screens were negative, we got lax about isolation.”

“I’ve read that children seem less affected by this new coronavirus,” Faith said, relieved that Brian had disappeared. “It seems to me that we could be spreading coronavirus quickly with children who don’t even know they are ill. I’m all for sparing children, though.”

“But not as contagious in children as influenza?” Peggy asked.

“That’s what I’ve read,” Ann said. “Everyone seems to want a vaccine for this as soon as we can develop one, and yet only half of adults are vaccinated for Influenza. How do you figure that? Do you think people will get vaccinated if we get a vaccine? What if vaccination only makes the disease milder like influenza vaccine does? Will we only have fifty percent of the population vaccinated?”

Faith asked, “Will it have to be an annual affair?”

“I don’t know,” Haley said. “Don’t forget, this is a coronavirus like every seasonal cold virus. Remember, it’s not an influenza virus.”

“OK,” Peggy said, “today, I’ll work on how to get tests, since, if nothing else, we need to know how to get one, how to collect the specimen, and where to send it. We need to stay ahead of the game where we can. If this turns into a significant epidemic, we have a lot to learn, things are going to change rapidly as we get more information, and, like all science, we will go back and forth about what is truth and what is conjecture.”

After rounds finished, Peggy migrated to the fellows’ closet to find a phone number for the Bernalillo County Health Department Epidemiologist. “Calvin Wickman,” the voice announced.

“My name is Peggy Valdez. I’m the attending for the obstetric service at UNM Medical Center. I need to know how we test a patient for COVID.”

“I have a limited number of test kits, and I have to send the specimen to the CDC in Atlanta to run the test,” Calvin said. There was a pause. “Doesn’t your UNM Medical Center Lab do that testing?”

“I didn’t call them. I don’t want to start a panic,” Peggy said.

“Well, I suppose I could come tomorrow to do the test.”

“You don’t have capability today? The sooner we find out one way or another is better for us to contain it if she is positive.”

“Well, I’m pretty busy today,” Calvin said.

“Can I come get the kit and then bring you the specimen?”

“I would rather not do it that way.”

“So, how do I get her tested today?”

“Well, maybe I could come a little later. You realize this would be the first case in New Mexico if she’s positive.”

“I do, but does that make a difference?” Peggy was getting testy. “We need to take care of this patient, we need to protect the rest of the patients in this hospital, and we need to protect us.”

“If you insist.”

“How many tests have we done in this state? Is it possible that we have cases we are unaware of because testing has not yet been extensive enough for us to know about them?”

“I have only done two, and both were negative.”

“When will you be able to arrive?”

“I’ll be there in an hour.”

The epidemiologist refused a handshake from Peggy when they met in the lobby of the Medical Center more hours later than seemed reasonable. Peggy and Calvin trudged to the back of Labor and Delivery, a section containing three rooms, the ICU, and a recovery room, separated by doors which allowed for isolated. Peggy introduced herself to the patient. All in Spanish, used for confidentiality and not for linguistic necessity, they discussed the test, the tester, and the unlikeliness of positive.

“I’ve not been out of the country,” she said. “In fact, I’ve not even been out of Albuquerque since Thanksgiving. No one around me has traveled anywhere, except my aunt did go on a cruise over Christmas.”

“Where did she go?”

“The Caribbean,” she giggled. “She’s a Mexican from Yucatan and she goes on an eastern Mexico cruise! Go figure.”

“To each her own,” Peggy answered. “Anyway, we need to keep this hushed until we get a negative test.”

“No problem,” she said. Peggy thought she was unusually calm about it. “Is coronavirus a problem for my baby?”

“Not that we know of. Not like Zika.”

Her face showed her relief. “Good.”

“You act as if you have had this discussion before.”

“Yes. The intensive care doctor talked about it, but I don’t think we came to a conclusion. It sounded like he didn’t know how to arrange the test.”

“OK. Well, we’re ready to get this over with.”

Calvin, in keeping with his verbally declared attitude, thrust the test swab deep into her nose. She pulled away and exclaimed, “Easy, please.”

“I need to get up high in your nose for the test to work properly,” he insisted. When he was finally satisfied, “There.”

“That was ugly,” she said.

Peggy felt bad for her. “Sorry. I’ll get you the results as soon as we have them.”

“Just make sure the test is negative,” she said.

Pessimistic Calvin said “Unfortunately, it could be several days before we know.”

Chapter 18

“It’s morning again,” Haley said. “Let’s get started.”

A list of patients and their problems went by. Brian, analyzing floor tiles, was mute.

Haley said, “The patient we tested for COVID was negative.”

“You tested the patient?” Brian asked. “On whose authority?”

“Peggy arranged for the test and got it done,” Haley said. “She had to get it from the Bernalillo County Health Department, and it has taken several days to get the result. The patient has already gone home. You would have known if you had not left before rounds were over.”

“I can’t believe you all do things like this,” Brian said.

“I’m glad it was negative,” Ann said. “We would have exposed a lot of people to that patient.”

“How come I didn’t know this?” Brian asked.

“You weren’t the attending of the day,” Haley said, “and you left before rounds were over.”

“Excuse me,” he said. “Please don’t talk to me that way.” There was dead silence. The group started to adjourn, but as soon as Brian disappeared, Faith said, “Ann, can we talk about something?”

“Yes,” she said. “What’s on your mind?”

“Anything. We didn’t have teaching rounds yet this morning.”

“OK,” Ann said. “The conference room in five minutes?”

The discussion was lively, in depth, and satisfying, including the use of masks and handwashing with COVID, all still controversial. After the conclusion, Josh left the conference room for his next task. Brian appeared from nowhere. “I want to talk to you.”

“OK,” Josh said.

“Are you trying to steal my wife?”

“Um, trying? Um, your wife?”

“Yes. Why are you trying to steal my wife?”

“Um, well, she is not your wife anymore. And I love her.”

“What do you mean?”

“You signed your divorce papers, remember? The one my sister prepared for her and gave to you. I think they have been filed, too.”

“So, you actively stole my wife? You even made the divorce happen? What kind of lowlife does that?”

“No. I didn’t make it happen. Faith made it happen. And you went along with it. Signing the papers means you agree.”

“But you facilitated it. You gave her an easy way out. You tricked me into something I didn’t want or mean to do.”

“No. No one tricked you. You can make decisions for yourself. You could have contested, but you didn’t. You were the one who was unfaithful. You were the one who chased her away. I guarantee you I will not do that to her. She is a wonderful, talented, bright woman that anyone should be thankful to know.”

“I can’t believe this. You stole my wife.”

“I don’t think so. You’re the one that gave her chlamydia.” Josh started to wander away.

“Wait! How do you know about that?”

“She told me. In front of you, in fact.”

“That’s none of your business. You need to keep your nose out of places it doesn’t belong.”

“You forfeited your relationship with her. No, you sabotaged your relationship with her. This is on you.”

“You will regret this,” came from behind as Josh fled down the hall.

Brian stood flabbergasted. How had this event been pulled off right in front of him? Was everyone out to get him?

Chapter 19

“I always enjoy a good steak,” Jim applauded. “This was perfect. I was hungry after the stairs.” Jim was sitting between Marianna and Natalie, facing Faith and Josh at the table. “That’s predictable, Jim,” Josh jested. “You’re from Texas.”

“They don’t like steak in Oklahoma?”

“Oh yes,” Josh teased. “Angus of the pure kind, not the Texan mix breed.”

Jim sputtered. Marianna cut him off before he could respond to the joke. “Does your family get down here to see you often?” she asked.

“No,” Josh said. “They haven’t been here yet. It’s quite a long drive, and Clinton doesn’t have any commercial air service. I talk to my sister often, but she hasn’t been here either. I guess it works both ways, I haven’t visited her or my parents since I’ve been here.”

“Tell me about your sister,” Marianna said.

“Well, she’s four years older than I am. She went to law school at the University of Oklahoma in Lawton. She works in a family law firm in Santa Fe with her law school classmate who’s from there.”

“How do you manage a lawyer and a doctor in the same family?”

“Daddy,” Natalie said, “I can’t believe you asked that question.”

Josh was ready, “With lots of silly doctor-lawyer jokes.”

Jim said, “Tell me one.”

“No, Dad,” Faith said, “They’re not nice!”

Jim persisted, “I want to hear one, then.”

“No, Dad!”

“What do you do if you find fifteen lawyers in a pit up to their waists in concrete?”

“I don’t know, what?”

“Order more concrete!”

“Whew,” Faith breathed. “Thanks, Josh.”

“Tell another one,” Jim said.

“What do an honest lawyer and a UFO have in common?”

“I don’t know.”

“You often hear about them, but you never see one.”

Jim chuckled. “That is a good one. I can use that at Saturday morning coffee with my friends.”

“Oh, man,” Natalie said, “that’s a bunch of sad, old geezers.”

“Young lady, watch who you call sad.”

Josh laughed. “I love your snark, Natalie. And thanks for helping me get through to Faith. I found out you helped me out with the yellow roses. I was beginning to wonder what it was going to take.”

“Sometimes she has trouble with the big picture.”

“She’s always been like that,” Jim said. “Her kindergarten teacher said she had trouble getting the main idea. I think I have to agree.”

“I think I’ve noticed that. We know a couple who are probably moving in together at about the same time as we are, and Faith still doesn’t see the connection between them. I guess I have an advantage because the dude is my second cousin, but it should be glaring to anyone.”

“This is a couple you work with?” Marianne asked.

“Yes,” Josh said. “They are made for each other and are so much fun when they are together. They lighten things up. The woman is the gossip queen.”

“Gossip?” Natalie said. “That leaves Faith out.”

“It leaves me out, too,” said Josh. “I don’t go for that sort of thing. I would rather get to know someone directly, and not through wild stories or imagination.”

“I agree with you,” Jim said. “Lubbock is full of gossip queens. I’ll fax you a list.”

“Thanks,” Josh said. “When I first began going out with Faith, it was not general knowledge. I don’t know how she escaped Haley’s radar, but she did. The only way I could get to know her was directly. We work together, but that doesn’t mean we have much time for personal talk. It might have been why it was so hard to break her shell.”

Natalie said, “She has a shell, all right. She also can put you on ignore, making you yell at her to get her attention.”

“That I haven’t seen,” Josh said. “But sometimes you do have to have a conversation with her a second time to make it stick.”

“I’m not that bad,” Faith said. “You, of all people, talk to me better than anyone has in my life — except maybe Natalie.”

“You seem quite laid back, Josh,” Marianna said. “Is that a fair statement?”

“Probably. An introvert. Like, Faith just blurts out questions right in the middle of a discussion by one of our attendings, which I can’t bring myself to do. I wish I could, because usually, when the opportunity to ask a question finally comes up, I’ve already forgotten it.”

“That’s why I do that,” Faith said. “I’ve told each of our attendings that I’m not trying to be rude or challenge what they’re saying, I’m just trying to fill up my brain. If I don't ask, I won’t ever ask.”

“What do you guys do for fun?” Natalie asked.

“Sleep,” Josh said, looking at Natalie out of the corner of his eye. “Besides work, meals, and laundry, there isn’t much time. Meals are about the only time for talk. We did go up the Sandia Peak Tram, and we have walked around Old Town.”

“I thought life would be better after medical school,” Jim said. “When does ‘the good life’ come?”

“According to our mentors, never,” Faith said. “I am hoping that’s not quite true.”

“Marla says it’s true,” Josh said. “She says she works as hard now as she did in law school.”

Jim said, “Anything done well is hard work. No job well done is forty hours a week.”

“Brian was a little like that, Dad,” Faith said. “Forty hours a week and home on schedule. Not completely, but some. I think it has limited him.”

“That’s a heavy statement,” Josh said. “I’ve never heard you talk about him that way.”

“I would agree with that,” Natalie said. “I sometimes wondered what mattered to him in life. What would he die for?”

“Whoa, Natalie,” Jim said. “Where did you come up with that?”

“Have you ever heard him talk about anything he seemed passionate about? What did he do besides watch movies? He used to run, but not recently.”

“Movies. Yes, he did that,” Faith said. “He was on me if I didn’t get home from work on time. He always said if my shift was over, I should leave. But sometimes the best learning comes at unexpected times and I can’t tear myself away from those moments.”

“I like that part of Faith,” Josh said. “I like lots of parts of Faith, but I like that she isn’t rigid like Brian.”

Natalie was chuckling.

“What are you laughing about?” Josh quipped, anticipating whatever snark was coming.

“I was just thinking about what parts of Faith you liked most,” she said.

“Natalie, behave yourself,” Marianna said.

“I love it,” Josh said. “I’m just glad I found Faith.”

“It’s important to find faith,” Natalie said, which got no reaction, so she went on. “I hope you treat her better than Brian.”

“What do you mean?” Marianna said.

“Brian was mean. He just wanted to dominate. I didn’t like that.” Natalie looked at Faith. “That’s the truth, isn’t it, Dr Faith?”

“Maybe,” Faith said. “Until Josh, I didn’t see it that way.”

“See, Josh,” Natalie said, “she can’t ever see the obvious.”

“I think she deserves better than that, and I plan to treat her very differently,” Josh said. “I promise not to dominate. We haven’t even had a real argument yet.”

“One of the things he does, Mom,” Faith said, “is he empowers me. The night he talked to Marla about the divorce papers he told me that the papers didn’t mean I had to do anything. I could use them or not. He never bosses me around or tells me what I have to do.”

“You boss me around,” Natalie said.

“You’re the little sister,” Faith said. “I’m supposed to boss you around. It’s my job.”

“Aren’t I the light of your life?” Natalie asked.

“Um, no.”

“Now girls,” Marianna said.

“Marianna,” Josh said, “I want to see ‘giggly wiggly.’”

“I think you did earlier today when we arrived at your apartment, when Faith and Natalie went in together,” Marianna said. “Wasn’t that ‘giggly wiggly’ enough for you?”

“I guess I was thinking that was squealy wheely, or whatever,” Josh said.

“I’ve always called it ‘giggly wiggly’ because that’s how they were. When they were younger, it was more wiggly, and now it’s more giggly.”

“I think it’s wonderful,” Josh said.

“Josh,” Jim said, “you’ve made me comfortable having Faith move in with you. For us it was sudden, and I wasn’t sure what I thought of it. It seemed like Brian was gone and you pounced on the scene like a lynx on a squirrel. I was frankly alarmed. Now I’m not. Just take good care of her, will you?”

“Yes, Jim,” Josh said. “I promise.”

The group moved to the parking lot where there were handshakes and hugs. To aggravate her, Josh attempted to hug Natalie, who ran a circle in the parking lot yelling, “Get away from me!”

Marianne hugged Faith and then Josh.

“Thanks so much for helping,” Josh said. “It wasn’t as bad as I thought. She didn’t have all that much stuff.”

“No problem,” Jim replied. “Come see us in Lubbock soon.”

“We’ll try, Jim. We’re only off together one night in three. Makes it tough.”

The Pernitelli family hopped back in the pickup truck, loaded with Faith’s bed, dishes, and coffee table, headed for Lubbock.

Chapter 20

Brian laid the sheet on Peggy’s desk and went away. He would come back when she was in.

A few hours later, Brian saw Peggy at a distance in the hall and followed her to the fellows’ closet. He paused for a moment in front of the door, wondering if confiding in Peggy was a good idea. So far, the old girl had been a reliable sounding board, secrets apparently unable to escape her mouth. Not true of Emily Beacham, Michelle Scroggins, or the Pain Management folks. He opened the door and entered.

Peggy looked up from the report Brian had left with a face that showed disbelief. “What’s this?” Peggy asked.

“It’s the final report on the drug screen they did on me a while back. They analyzed the opiates and found oxycodone, which is in Percocet, and fentanyl.”

“I see that. Where is the fentanyl coming from?”

“Around.” The old wooden rolling chair groaned as Brian sat.

“Cripes, Brian, that’s not good. This will make your detoxification a lot harder.” Peggy stared hard in Brian’s face. “No tiny pupils today. Who tested you, anyway? The lab report says JDT. Who is that?”

“JD Thompson is the Dean of Faculty. Emily and Michelle made me meet with them and him, and they tested me. They recommended — more like forced — me to see Pain Management and make a plan.”

“So how is that going?”

Brian squirmed. “I have only had two appointments, one with the psychiatrist and one with the counselor. I am supposed to go to NA meetings starting next week.”

“You don’t have small pupils today. Are you still using fentanyl?”

“No. I haven’t had fentanyl for several days. I might have to have some tonight, though. It was hard to sleep last night.”

Peggy didn’t respond. After sitting for a period of silence, she finally asked, “What did the Pain Management people say?”

“They didn’t say anything, but they know. This came today.”

“Maybe that doesn’t change the plan.” Peggy said.

“Maybe.”

“What do you think?”

Brian said, “I knew about the fentanyl—”

“You think?”

“— but I can manage it fine.”

“Is there anything I can do?”

“No.”

“Why did you come to share this with me? I would have had no way to find out, otherwise. And I don’t make management decisions — actually I wouldn’t make management decisions about detoxification since I know nothing about it.”

“I figured you would be all over UpToDate about it and have some pearls.”

“I don’t. I didn’t. But why are you revealing this to me?”

“I don’t know. I didn’t reveal it directly to Pain Management, but they have the report. I guess I just thought you should know.”

“How do you administer your fentanyl?”

“A patch.”

“You can buy patches?”

“Yes.”

“Where do you get them?”

“Around.”

“Are they expensive?”

“Yes.”

“From the questions I just asked you, you know I don’t know much about this. I don’t have any advice to give you. Except maybe stay away from the people that sell fentanyl since they tend to be dangerous.”

“Pain Management doesn’t seem to have any advice either.”

“You always say Pain Management,” Peggy said, “don’t you see the same person every time?”

“My counseling sessions, yes. My psychiatrist, no.”

“What did they tell you the plan was?” Peggy asked.

“Gradually decrease the opiates. Start suboxone later.”

“To help with temptations.”

“I guess.” Brian got up and left the room, closing the door very gently. The frosted glass window didn’t notice. He felt good about the exchange as he strolled down the hallway, but empty about it in the elevator. Where was this going? Why did he feel so compelled to tell Peggy?

Chapter 21

An idea blinked in Brian’s brain. He had not lived in the apartment with Faith two months he had paid for. Recovering that would help a little. Fentanyl was expensive, Percocet wasn’t cheap, and good weed was hard to find. The computer revealed the call schedule. She was off tonight, and Josh was on call, making the perfect opportunity.

Brian drove to her — Josh’s — apartment. The windows were dark. Several knocks on the door went unanswered. For a time, he sat in the car, listening to the radio, which only increased the ire he felt. Finally, he ascended the steps and knocked again. No answer. He sat and leaned back against the door, closing his eyes to think. He was awakened by a scream as she approached the landing in the dark. “What are you doing here Brian?”

“Did you move in with him?”

“What business is that of yours?”

“We were together for seven years, married for four years, and in less than two months you move in with someone else?”

She pushed by him and put her key in the lock. “What do you want, Brian?”

“I think you owe me money.”

“No.”

“Yes. I didn’t live in our apartment last month or the month before, but I paid the rent.”

“That’s because at the beginning of the month before you did live there. I paid for two months. You should really have to pay for the rest of the lease. It’s only because I helped the landlord find another tenant that you don’t have to pay until June!”

“You owe me for your half of the last two months,” he insisted.

“No.”

He seized her right arm. Almost simultaneously, she kicked him where it counts, catching him completely off guard, and paralyzing his breathing. He buckled over and crumpled to the floor as she pushed by him, opened the door, slipped in, and closed the door. He heard the knob turn, the dead bold click, and the chain slide into place.

For a few seconds there was nothing he could do. Clambering just to take a breath, a wave of nausea washed over his head leaving prickly moisture in his hairline. Breathing for a few minutes, in which he analyzed the event, he stood like an arthritic old man, mustered strength, and pounded three times on the door. “Open the flipping door, Faith!” The deep throbbing pain continued.

“No. I’m not opening the door. I’m not paying you any money. You signed papers stating that you would have no subsequent claims. Remember? Forget about it.”

He beat the door harder this time.

“No, Brian. You’re not coming in, and you’re not getting money. If you don’t leave, I’ll call the police.”

“You don’t have the guts for that.” He beat on the door again, ignoring the threat he knew was idle. He heard the start of a conversation with nine-one-one, stating her name, her problem, her address, and then answering yes to several questions. Had Josh taught her this, too?

“Did you call the police? You weasel!” How could she do that?

“Yes.”

“I can’t believe this,” he said, then took a breath. “Why don’t you open the door and talk to me civil-like about this?”

“Because something might start hurting you really bad again. Do you want that twice in one night?”

“You wouldn’t dare.” Where had this come from? Was Josh brainwashing her, putting ideas in her mind, alienating her from him?

“Why don’t you stay out there for five more minutes? Then you can tell someone in blue why you are pounding on my door and why you got kicked in the nuts.”

“Forget it!” Defeated and miserable, he limped down the stairs, pushed through the atrium door, and vomited in a shrub. He had to sit in his car for several minutes to calm his nerves, let his pain subside, and push away the nausea. It was a bad dream. What had happened? This wasn’t Faith.

Chapter 22

Josh, come here,” Faith called from the bathroom. “Look at this.” She was holding something in her hand.

“What’s up?” he asked, then choked up. “Is that what I think it is?”

“Yes. I’m pregnant.” She looked at him mournfully.

He looked at the test strip. “Wow. That’s wonderful!”

“What?” she gasped.

He didn’t repeat.

“Did you say wonderful?”

“I did.”

“How can you think that? This really isn’t a good time for me to have a baby! I’ll be a second-year resident. How’s that going to work?”

“When would be a good time for you to have a baby? Both Peggy and Marla say we’ll never get less busy or less encumbered. This is as good a time as any.” He tried to hug her, but she pushed him away.

“Are you being real?” She looked at the strip again. “This is the second test I’ve run. I did one yesterday.” She wiped her eye.

“But you have told me you eventually wanted to have children. I can’t think of anyone I would want to have children with more than you.”

“I can’t believe you are excited about this,” she said.

He decided to speak his mind. “I’m excited about this. I’ve always wanted to have children. I didn’t want to make that happen right here and right now, but now that it’s happened, I’m elated. I hope you can be, too.” He paused. “I know that all this has been super-fast for you, but I’ve had all summer, fall and winter to think about you. I spent that time admiring the person you are, your intense drive, and the soft, sweet passion inside you. I now feel so lucky to have you that there is almost no way you could disappoint me. So, you can’t blame me for thinking about the future a little.”

“Here I was thinking about an abortion, and if you would insist that I have one. Brian would’ve.”

“I wouldn’t stop you, but I don’t want you to.” Then sternly, “I’m not Brian.”

She got a naughty grin on her face, “How do you know the baby is yours?”

“I trust you. Besides, you’re a horrible liar.”

They stood side by side looking in the bathroom mirror. He enjoyed the smell of her shiny, silky black hair, the faint freckles on her nose, and her square, tall forehead.

“I have to think,” she said. “I’ve never been pregnant before nor even thought about it much. I’m still trying to make it real.”

“You are,” he slowly pronounced, “a primigravida.”

“Oh. My. Gosh. Did you really say that?”

“Yes. I just wanted to see you smile and it worked.”

“How do you know I’m not a multigravida?”

“You told me just now you’ve never been pregnant before, so you’re pregnant for the first time. Primigravida. I think you would have recognized the signs of pregnancy quicker if this wasn’t your first pregnancy. I know I will next time.”

“Next time?” she asked. “Are we talking about another baby already?”

“No, I’m just saying that I didn’t know the signs well enough before, and that if it happens again, I’ll pick up on them quicker.”

The change-of-subject face appeared in the mirror. “Are we going to have a baby?”

“I vote yes. But you have two votes. After all, you hold the temporary residence of the creature.”

“I wasn’t ready for this.” She was misty. “I do want to have a family, but not now. Help me.”

“I support you either way. I still don’t think there is a better time in our lives. We aren’t going to be less busy at any other time in our careers, according to those around us.”

She nuzzled into him. “You said ‘our’ lives. I haven’t thought of this as ‘our’ yet.”

“OK. I think I pushed you into our relationship, and I pushed you into moving in with me. I didn’t do it on purpose, but I pushed you into a pregnancy. I’m trying not to push you again, push you too much, make you afraid, or chase you away. But I want to push you like crazy. I’m just nuts over you, and I can’t get over it.”

She looked at his face again. “It’s scary.”

“Me being nuts over you is scary?”

“No.”

“Is having a baby scary?” he asked.

“You bet!”

“Is having an abortion scary?”

“Yes!”

“Which is scarier?”

“I don’t know.”

“Take your time and decide.”

“Well,” she said, “now I know where you are. The hardest part is not knowing or thinking wrong.”

He kissed her forehead.

“I don’t want an abortion,” she said, surprising him. “But I don’t know if I want a baby.”

“There is another option, but I don’t like it.”

“What?”

“Adopt away. That would be my least favorite.”

“I hadn’t considered that, and I don’t want that one either.”

“That’s progress.”

“What?”

“There are only three options,” he said. “Abortion, adoption, parenthood. If I heard you correctly, you ruled two of them out.”

“You tricked me!”

“No. You don’t have to stick with what you said tonight. It’s OK to sleep on it, process it, mull it over. And up to a point, you can change your mind any time. You are empowered.”

“I like empowered. You do that to me all the time. Brian never did it.” Even though the change-of-subject face appeared, she surprised him again. “It had to be the night I moved in.”

He tried to think. “That’s right. We’re only here together once every three nights, and we were busy at work and at home that first week or two you were here. I think you’re right. So, that gives us a due date.”

“Uh-huh,” she said, rising to retrieve a gestation wheel. “Using that conception date makes September 22.”

“Wow, September 22.”

“September 22.” She turned and hugged him tightly, wiggling a little, and finally squealing a little. “September 22.”

“Is this what your mom meant by ‘giggly wiggly?’”

“Josh!”

“Well, that’s what she said.”

“We’re going to have a baby!”

“You made that decision fast. Are you sure?”

“Yes,” she said, sitting down beside him, legs under her. “I was trying to figure out how to talk you out of an abortion, which I was sure you would insist on. I was afraid this might break us up, to tell the truth. Then how would I deal with seeing you at work every day?”

“Because you would have insisted on not having an abortion?”

“Yes.” She was facing him now. “I’m sorry to have cast that upon you, but I did. Not only did you agree to have a baby, but you also agreed not to have one. The thing I love you most for is that you empower me, and now you’re doing it again. It’s something I’m not used to. You will have to put up with me until I quit thinking Brian’s way.”

“I’ll put up with you for a long time if you let me. Can Brian please not live here? I just want you to stop thinking Brian’s way.”

She said, “I’ll work on that. Really hard.”

“You’ll need some prenatal vitamins. I’ll take care of the Negra Modelo for you. I think I’ll have some now.” He rose and strutted to the kitchen, returning with a large glass mug of the smooth liquid. “Would you like some water, honey?”

She punched him in the arm, spilling a little beer on his shirt. “No thank you, dear.”

Chapter 23

“Hi, Ann,” Faith said as Ann entered the exam room.

“Hello, Faith — and Josh.”

Josh recognized the confusion on Ann’s face. “Faith lives with me, and this is our baby.”

“OK,” she nodded. “I did not know that. In fact, I only recently heard, from you-will-never-guess-who, that you were married to Brian Yankton. Gad.”

“Yes,” Faith said.

“So, is this pregnancy a surprise?” Ann asked.

“Yes, because I had to move in with Josh suddenly and we didn’t talk about contraception.”

Ann said, “Great! Two Ob-Gyn residents didn’t think about birth control?”

“Kind of screwed up, huh?” Josh mumbled.

“You could say that.”

“Anyway,” Faith said, “Thanks for calling me.”

“No problem. We had a cancellation in an afternoon that was already light, and I figured you didn’t want to wait.”

“True. Not that there’s a critical problem.”

Ann collected historical information and clicked away on the computer. “You have psoriatic arthritis? How do you function off medicines?”

“Poorly. Sometimes I can’t even hold a pencil. I’ve been on Humira five, almost six, years.”

“There’s getting to be observational data on biologics, and they are currently pregnancy category B by the FDA, or, as safe as you can get for medications. I wouldn’t worry about Humira. But your baby may need to have its first vaccinations delayed. We know it crosses the placenta.” Ann completed a physical examination. “I don’t feel the uterus above the pubic bone yet,” she said, poking around on Faith’s belly. “We’ll see here in a moment.”

With the exam finished, Ann wrapped Faith in her gown and sheet, and Faith scampered down the hall to the ultrasound room, Josh right behind.

“No tech?” Faith asked. “Don’t we usually have an ultrasound technician perform the scan and store the images?”

“Yes, but the less eyes we have, the less mouths we have,” Ann said.

“Thanks,” Faith said. “I didn’t think of that.”

The vaginal probe went in. Ann adeptly identified a live fetus, agreed with eleven weeks, and came up with the same due date, September 22.

“We haven’t told anyone,” Faith said. “We haven’t even told our parents, yet.”

“I think it’s important for this office to keep its mouth shut. What you say and to whom you say it is your business. I just don’t want the source to be us, here.” Ann was stern. “In an Ob-Gyn office, it’s hard to keep a lid on sensitive information, but it can be accomplished.”

Then Ann summarized. “OK, let’s see. Singleton pregnancy, three vessel cord, can’t see the gender, placenta in a good place, heart has four chambers. All that seems normal. We need to do your routine blood work and another ultrasound in a couple weeks for genetic screening. Start taking prenatal vitamins.”

“Do you think boy or girl?” Josh asked, winking at Ann.

“Girl.”

Faith gasped.

Ann then confessed. “I’m not completely sure of that. Don’t buy any dresses.”

“So, you didn’t see a penis, Ann?” Josh asked.

“No. I said everything was normal. A penis would be a birth defect.” Ann smirked.

“Yes, because that would make it a man,” Faith added.

“OK, you guys! Is that Faith making jokes?” Josh said. “We don’t need to know for sure, and I don’t care. But having a hint is fun.”

“I don’t care either. I just want healthy. I’m already in love, whoever it is.”

Josh said, “Hezekiah Menkowicz.”

The women started laughing.

“Thanks, Ann.”

Faith got dressed and left the room, a beaming Josh right behind. Josh needed to get back to work so he could get home, and Faith had blood tests and other things to do before leaving the office. Josh sported through his work, headed for home to fix dinner, and had it on the table when she came in.

She was giddy when she entered the apartment, threw a jacket and bag on the couch, and plunked onto a chair in front of her plate. “Could you believe our baby today?”

“Yes! Singleton, live fetus with normal appearing anatomy.”

“Did you see the report already?” she said. “You aren’t supposed to look at my chart!”

“No, I made that up. I didn’t look in your chart. I don’t believe there are secrets. I trust Ann.”

“Me too.”

He was inhaling his dinner.

“We’re going to have a baby.” She became serious again. “We’re going to have a baby.”

“I’m so happy about that. I was thinking about what she would look like, what she would become, how you would dress her up.” He was grinning so hard it was impossible to swallow.

“Now that I’ve seen her, I can’t wait to meet her,” she said. “It’s fun to think of a girl.”

“It’s a boy,” he said, just to torment her. “He just needs to grow some balls.”

She giggled. “No, a girl. You have a daughter, daddy.”

He almost choked on his mouthful. “I didn’t think about that. I have a daughter? I’m her father? Wow.”

“Is that bad?”

“Not at all. I just hadn’t thought about being a father and having a daughter. I’m so excited. I can’t wait.” The meal went on. “We could call her Marla.”

“Or Natalie.”

He thought for a minute, “Brunhilda, Ludmilla—”

“Jeez, Josh!” she said. Then, with a sneaky look on her face, “Cruella.”

By now, they were holding hands. She said, “Cori.”

“Cori,” he repeated. “Corrine? Corona?” then started to laugh. “Not Corona.”

Her eyes pierced into his, “Cori. Not Corrine or anything, just Cori.”

“Where did you get that?” he asked.

“I don’t know. It just came. It had nothing to do with coronavirus, I don’t know anyone with that name, it just came. There’s no one in our family named Cori.”

“It’s nice,” he said. “I like it.”

“Are you saying that just to appease or empower me?”

“No,” he said. “truly, I like it. I don’t think there is a Cori in our family either. I probably will tease our friends with Corona, but I don’t mean it.”

“Especially Haley,” she said. “She so deserves it.”

If you take a shower, I’ll clean up the kitchen.

“What?” she said, “Do I stink?”

“Yes!” He gave her a cheesy grin. “No. But you were on call last night and I bet you didn’t have one. Usually, you do shower when you get home after call.”

“Yes,” she said patting his shoulder on the way to the bathroom.

“Cori. I love it now.”

Soon the two were facing each other on the couch with their legs outstretched and meshed. Faith was in her terrycloth robe with a towel on her head, and Josh had on shorts and a t-shirt. He noticed Faith was staring at him.

“What?” he said.

“We’re going to have a baby.”

“I’m glad we’re not having two.”

“Jeez,” she said, “I never even thought about that!”

“Dr Valdez told a patient that in order to have twins you have to do it twice in one night.” Josh enjoyed the look on her face, then added, “In that case, we should be having triplets.”

“Joshua Menkowicz you are the worst.”

“Where did you learn that?” he said. “My mom would say something like that.”

“Maybe Cori will run with me,” she said. “We can play in the park. Maybe we need a dog.”

“Hold it right there. One major change at a time. I know how much work a dog is. I imagine a baby is even more work than that. We don’t need them both at the same time. Let’s get used to Cori and then think about a dog.” He kept staring at her while he thought some more about Cori and a dog. “I suppose a house and a picket fence? How about a minivan? You certainly have come a long way from not wanting a baby as a second-year resident.”

She pulled one side of her mouth up, “I have. I’m a lot less scared of this now. And Josh, you know that’s really because of you. I can’t imagine being in this situation with Brian.”

Josh poked her thigh with his heel. “You have to get Brian out of here. He is gone. Let it go. He doesn’t live here.”

“Are you really that angry about it?” She gave him a little pout.

“No. But sometimes it ruins the moment, like just now. This is our baby. Brian has nothing to do with it. It’s not his, it’s not his business, he doesn’t live here. This is just for us.”

“I agree.” She kept looking at his face, and he held her gaze. “I don’t mean to be a pain about it.”

“I know.”

“I’ll work on it, I promise. It’s just really hard. You know we see him almost every day.”

“That does make it tougher,” he said. “But I want him out of this house and Cori in.”

She didn’t answer. The change-of-subject face stared at her phone. “Hello, Dr Faith,” Natalie’s cheery voice heralded.

“What’s new, Nat?” Faith asked, procrastinating.

“Not much. I like earth science in school.”

“You’re becoming a nerd like me.”

“No. Not happening.”

“I have some news.”

“What news?” Natalie asked.

Faith hesitated. “I’m pregnant.”

“How good,” Natalie cheered. “Or is it?”

“Yes. I am worried that I will be a second-year resident and have a baby, but nobody thinks there’s a better time.”

“When are you due?”

“September 22.”

“Whose baby is it?” trepidation leaking into Nat’s voice. “Brian? Or Josh?”

“Josh, of course.”

“Oh good,” Natalie said. “Boy, that would be a nightmare.”

“I hadn’t thought of that. No, she’s Josh’s.”

“She?”

“We think so. I am only eleven weeks, so we are not sure, but we didn’t see a penis.”

“That’s so exciting,” Natalie was squeaking. “I’m excited. I’m going to be an aunt.” There was a pause. “Are you ready to tell Mom and Dad?”

“I think so.”

There was some shuffling, then Jim’s voice, low and smooth, said, “What did you tell Natalie?”

“I’m pregnant, Dad,” she said. “We’re going to have a baby in September. We think it’s a girl and we might name her Cori.”

Marianna’s laugh took over the conversation. “That’s so exciting.”

“You realize, that makes you Grandma.”

“I’m ready,” Marianna answered. “I thought about it after you married Brian, but then I thought about it the day we came to help move you in with Josh.”

“It’s Josh’s baby,” Natalie said.

“That’s good,” Marianna said. “What do you think of this, Josh?”

“I’m excited. Faith picked out the name Cori, and I love it.”

“That’s one of the names we talked about when we had Natalie,” Jim said.

“I don’t remember that,” Faith said. “I was only eleven when she was born. Maybe that’s where I got the idea, but I don’t remember talking about that name.”

“It’s a nice name,” Marianna said, “but what if it’s a boy?”

“Hezekiah,” Josh said. “Hezekiah Menkowicz.”

There was a period of silence, but Natalie couldn’t hold a laugh any longer. “How about Ralph?”

Jim’s chuckle came across.

“We didn’t talk about a boy’s name,” Josh admitted. “If this kid grows some balls, we will figure out something.”

“Giovanni,” Jim said.

“After you?” Josh said.

“I didn’t know if you knew my name.”

“Faith filled me in. What I haven’t reconciled is where Giovanni and Marianna decided to name their children Faith and Natalie.”

“Both of us were born in America,” Jim said. “We wanted American names. I have always used Jim because it’s easier for Americans to remember, and it’s what Giovanni means.”

“I can’t wait to buy her some clothes,” Marianna said. “This will be so much fun.”

Josh imagined Jim’s eyes rolling. “Don’t buy any dresses yet,” Josh said. “We aren’t sure enough.”

“That won’t stop her,” Jim said. “It won’t stop Natalie either. I am staying home when they go out shopping.”

“Good choice, Jim,” Josh said.

“We just wanted you to know,” Faith said. “We aren’t telling our work colleagues yet, but you don’t talk to them anyway, so it doesn’t matter.”

“Besides Ricky, I don’t think we even know any of them,” Jim said. “I think the secret is safe. You guys need to come see us.”

“We’ll try to, Daddy, but we are not off together very often. And it’s a long drive for a day visit.”

“We know, honey,” Marianna said. “But if you can, do come.”

The call wound down and ended.

The quiet in the room and Faith’s face said it all to him. He thought about a diamond.

Chapter 24

“This place has completely changed since Friday evening,” Ricky said, getting morning rounds started. The group, rejuvenated by a Saturday off, was blindsided by a complete change of patients in thirty-six hours. “We now have two patients being ventilated in the medical ICU, a patient who will deliver soon, and another who delivered a few hours ago but had huge blood loss.”

Ann took over, “One of the patients in the medical ICU is a thirty-one-year-old at twenty weeks who developed fever, cough and difficulty breathing over the last twenty-four hours. So far, she hasn’t responded to any of our medicines. Her influenza A and B were negative, her strep screen is negative, and we’ll know about coronavirus tomorrow.”

Peggy asked, “Haley, what’s our coronavirus update?”

“Well, we didn’t have any cases in New Mexico until ten days ago, but now we’ve had more than a hundred positive tests. The Albuquerque schools are closed, the University has gone to cyber-classes, all the sports events, concerts, and tours are canceled, the mall is closed, and Governor Michelle Lujan Grisham has closed indoor dining at restaurants. Most of the senior living facilities have stopped allowing visitors. People have exhausted the stores of bottled water and toilet paper. We’ve self-isolated any first responders and emergency room workers who are waiting for test results. We’re now down to twenty-four hours for test results, and our University lab has started analyzing them.”

It became an open forum. “But this will be more deadly,” Faith said. “I read there are more deaths per case of COVID than influenza.”

Ann said, “COVID transmits more easily. It looks like it’s all through respiratory droplets, like with influenza, but nobody is sure about surfaces and body fluids.”

“In our modern medical environment,” Josh said, “we can isolate better. This should not explode into the influenza outbreak of 1918 to 1920.”

“I don’t know about that,” Haley said, “this is getting scary. It’s us who will have to deal with all the pregnant ones.”

Peggy said, “Let’s be careful, isolate suspected patients, wash our hands, don’t touch our eyes, nose and mouth, cover our face when we cough, yada yada.”

“This might become a big deal,” Ricky said. “There are a lot of deaths, more than you would expect from influenza assuming we know the number of infections—”

“Which we don’t.” Haley said.

“— and there are long ICU stays. There is concern about whether the health system can manage this.”

“Which it can’t.”

“Shut up Haley.”

“Well,” she said, “the east coast is already becoming overrun with ventilator cases and they are scrambling to build temporary hospitals and mobilize the navy’s hospital ships. That means we may be in the same situation in a month.”

“We can manage. They are,” Ann said.

Haley said, “No, they aren’t. They are trying to figure out where to put all those critically ill patients.”

Peggy wanted to stir the pot. “ICU occupancy is about ninety percent all the time. No hospital can afford to have empty ICU beds on a continuous basis. So, there isn’t much space available for something like this. We might have to stop doing elective surgeries that require ICU beds to accommodate the epidemic, then resume when things settle down.”

“That would throw a wrench in the works for patients who need heart surgery or big cancer surgery. How do we deal with that?” It was Ricky. “We figure out which ones can wait, like surgery for weight loss and joint replacements, but there are a whole lot of people who need intensive care when they need it.”

“You wouldn’t be able to delay transplants,” Haley said. “When you have the donor, you have the donor. And auto accidents.”

“Out here, we won’t have as much transmission because of our low population density,” Ricky said. “You’ll see.”

“Shut up, Ricky.” She put her phone to her ear and listened. “Yes.” She ended the call. “Our patient in ICU is positive for coronavirus. That’s our first pregnant patient.”

“OK,” Peggy said, “it’s going to get real now.”

After rounds had ended, Faith and Josh suited up and entered the coronavirus patient’s room. “Good morning Reyenne,” Faith greeted her.

“Good morning,” the wheezy subject answered. Her eyes were sunken, she was straining to breath.

“This is Josh, one of the other doctors here. His last name is Menkowicz, but Josh is easier.”

Josh looked at the pulse ox reading, ninety-three percent. He looked at the blood pressure, slightly elevated. He noted the elevation of respiratory rate. “Have you been coughing?”

“Yes, I just had a fit of coughing. Sometimes I cough so hard I throw up.”

“We understand,” Faith said. “Do you have some family here?”

“No. They were told to stay away. We talked for a few minutes by Facetime, but I fell asleep.”

“Your coronavirus test is positive.”

“They told me.”

“You know we’ll take the best care of you we know how,” Faith said.

“I know.” She paused to take a few breaths. “Am I going to die?”

“Not if we can help it,” Faith said. “We will do everything we can to prevent that.”

“What about my baby?”

“We don’t know everything there is to know about this virus, so we are playing it by ear, but we have not heard that it is bad for the baby. Just for you.” Faith, in gloves, held Reyenne’s hand.

“Why won’t they let my mom come in?” she whined.

“We don’t want her to get infected. We need to contain this as best we can. Neither your family nor other patients in this hospital need this disease.”

“I hate that, though,” Reyenne said. “I wish someone could sit with me.”

“I understand,” Faith said. “I would feel the same way. But for now, we need to be careful.”

“Please come back and see me,” Reyenne said.

“I will,” Faith promised.

The two wandered out of the room as the patient started to doze. In the hall, “Reyenne really doesn’t look good to me,” Josh said.

“Nor to me,” Faith said. “What disturbs me the most is how fast she is getting worse.”

“I wonder what that means,” Josh said. “I wish we knew more about this disease. What the prognostic signs are, which medicines work, which medicines don’t work, what lab tests should we watch.”

“I agree.”

They wandered toward the elevators on their way back to the Labor and Delivery charting station. On arriving, Ann was at the desk.

“Reyenne looks terrible,” Josh said. “I wish there was more we could do for her.”

“Me too,” Ann said. “What did you tell her?”

Faith’s voice quivered, “We told her we would take care of her the best we could.”

“That’s enough. That works.”

When work had calmed down, Faith and Josh went back to talk to Reyenne. “Do you have a husband?”

“Not anymore. He left when we found out I was pregnant. He didn’t believe the baby was his. He said some doctor told him he couldn’t ever have children.”

“I’m sorry. Are you excited about the baby?”

“I was. Then my husband left. That hurt me, but now I’m slowly getting excited about it again.”

“Have you thought about whether you want a boy or a girl?”

“Dr Ann thinks it’s a girl and showed me on the ultrasound. I already have two boys. I want to dress her up and take her out. I like to sew, so it would be fun to make her things to wear.” Her voice was thin and tinny, her eyes moved slowly to Faith and then Josh. “My mom says it is just as fun to make clothes for a boy, dress him up and take him out, but I like pink and lace and fluff.” She closed her eyes long enough that Josh thought she might have fallen asleep. When she opened them, “Do you have children, Dr Faith?”

“No. Someday I would like to.” More information was not appropriate.

The patient drifted off again, but Faith sat and held her hand. “Go do what you need to do, Josh. I’m going to sit here for a while.”

Josh took the hint and wandered away, thinking he may have seen the patient alive for the last time. If she died, it would be the first patient to die that he had taken care of in his life. While he knew the day would come, as it does for any physician, it made his spirit churn. He thought about what Faith must be thinking.

After rounds the next morning, Reyenne was on a ventilator when Josh and Faith arrived at her ICU bay. This time, her pulse ox looked better, but she still had sunken eyes, and her skin was sallow. Josh looked at Faith. “I’ve never seen anyone die.”

“Jeez, Josh!”

“Well. What does it look like?”

“I don’t know. Maybe this.”

Together, they scanned the chart in the bedside computer. The patient had received regular doses of Tylenol for fever, had her oxygen setting on the ventilator adjusted several times, and had received her steroids. She had an arterial line in her wrist so that blood gas specimens could easily be taken, and blood pressure and heart rate could be continuously monitored. She had a fever.

“I don’t like this at all,” Faith whispered. “What do we do? Just stand here and watch her die?”

Josh wasn’t calm. “We don’t have anything else to offer her. We don’t know what works, anyway. Come on, Reyenne, it’s up to you now, girl.”

The two wandered away. They were both quiet at afternoon rounds and quiet in the apartment when they got home. Faith talked to Natalie briefly. “This patient we have looks really bad,” she told her sister. “Josh and I talked about what it looks like when someone is going to die.” There was a pause. “No, I just wanted to talk.” Another pause passed with nothing audible from Nat. “I’ll talk to you later. Tell Mom I called.”

“Just think, what if this were Natalie or Marla,” Josh said. “What if it were one of our parents. We would want to visit, we would want to hold their hand, and we would want to talk to them all the time.”

“If she dies, she leaves two other children behind. Who is going to take care of them? Where do they go? What will they think when they grow up?”

“Wow. I didn’t think of her other two children. Two boys. Two brothers with no mom.”

Faith didn’t say anything. Finally, she reached over, kissed Josh and said, “I’m exhausted. I have to go to bed.”

Josh sat and stared at his laptop for a long time, ingesting none of the information in front of him. Giving up on learning anything, he headed for the bedroom. He sat on the edge of the bed and watched Faith sleep for a long enough to contemplate her as a mother and savoring the idea that a little person would soon share this bed. That night, he held her especially tightly, as though she could slither away if he weren’t careful.

Chapter 25

Peggy jumped when the frosted window rattled.

“Now they are threatening to terminate me,” Brian said, sitting backwards in the aging, squeaky, rolling chair, arms crossed on top of the chair back, and resting his chin on his arms.

“Based on what you said last time you were here, I would say they have a point. They can’t have somebody in the operating room high on fentanyl,” Peggy said. “Who is ‘they?’”

“JD Thompson and Emily.”

“Who is JD Thompson, again?”

“The Dean of Faculty.”

“Sorry, I forgot. What are they expecting of you?”

“They want me to go to rehab, move on to a surveilled probation, and then a structured work schedule.”

“OK.”

“But I don’t need rehab. I use Percocet for knee pain. I had an old injury, had arthroscopic knee surgery two years ago, but recently I am having trouble again.”

“Since the surgery, did you have a period of time when you didn’t take any pain medicines?”

“No.”

“So, who’s been giving you Percocet for two years?”

“Dr John Ballinger, one of our orthopedic surgeons,” Brian said. Peggy knew this not to be true. Brian hadn’t been here a year yet. Who did he get it from in Lubbock?

“So, what about the marijuana?”

“What about marijuana? What I do in my off time is not any of anybody’s business. I use it for my knee.”

“Where do you get it?”

“Around.”

“Well, it looks to me like you have a decision to make. Either you address the problem head on, tackle it with all your heart and soul, or you let the actions take their course and wind up without a career, facing felony charges, and without a paycheck. You know this accounts for a significant part of our nation’s homeless.”

“I don’t see why everybody thinks I have such a problem. I haven’t missed work, I haven’t made any errors, and I’ve done everything everybody expected of me.”

“No, Brian, that’s not even what you have told me. Emily wants you to start a research project or join one in progress, do some medical school administration, or get active in teaching rounds. We have noticed you late or absent for rounds, irritable with students, nurses, residents, and fellows, and not very instructive. Then there are the board exams and a divorce. How much do you need? Perhaps a two by four upside your head would help, as my dad would say.”

“Those aren’t connected.”

“You don’t think so?”

“No. Why would they be?”

“Most opiate addicts can’t function at work, their interpersonal relationships deteriorate, and their concentration and mental acuity suffers.”

“Do you think my mental acuity is suffering?”

“From what you have told me about good performance on in-service training examinations which has now deteriorated to failure on boards, I would say the answer is a resounding yes.”

“So, you think my board exams are because of my opiates?”

“Yes. What does Dean Thompson say?

“The same.”

“What is he suggesting you do?”

“Get off my opiates and marijuana, go to rehab, for which they recommended the Pain Management Clinic here at the University, and reset my life and career goals.”

“The sooner you do, the better.”

“I don’t see how you have helped me.”

“Maybe not yet.”

“What do you mean?”

“Brian, you have to recognize the problem, then you have to let people around you who are skilled at dealing with this help you get a grip on it. From what little I know it’s recognizing the problem that is the biggest obstacle.”

“I don’t see it.”

“This is a medical problem like all others. What if you had lymphoma or cancer of the pancreas?”

“I would go to a doctor and get surgery or chemotherapy.”

“So, what’s the difference? You’re at risk of dying of this just like you would be of lymphoma or cancer of the pancreas. You will not get well if you don’t meet it head on.”

“This has nothing to do with lymphoma or cancer. This is not like that at all. This is me coping with a problem with my knee and coping well. Staying at work, continuing to function.”

“You mean like your wife, your tardiness, your pinpoint pupils, and your board exams?”

“I knew you wouldn’t help. I’m out of here.” Brian got up and left the room, mumbling unintelligible syllables. He closed the door gently, but the window rattled in protest.

Peggy wondered if he would turn the corner or wind up in a tent in a park. Knowing that people dedicated to his problem were working on him was reassuring, and she didn’t think there was anything she could contribute. Maybe being a sounding board was helping. But even cancer of the pancreas and lymphoma when doggedly treated don’t always end well.

Chapter 26

The phone rang. “Dr Valdez, this is Ricky.” Peggy brushed shards of deep sleep away. She had to orient herself. She was at home, in her own bed. Ricky. Ricky. Blue lights from the nightstand said 4:30 am.

“Ricky. What’s up?”

“We thought we should tell you that our patient had a cardiac arrest. She died about two hours ago.”

“What? She died?” Peggy tried to push through a thick shroud of dream fragments. “Ricky.” She wondered why Ricky was calling her at home, but didn’t pursue the issue.

“Yes, Dr Valdez, Ricky.”

“Where are you?”

“At the charting station in ICU. I was trying to finish up the death certificate, which I’ve never done before. I’m making slow progress. When I think I’ve finished it, the computer rejects it.”

They discussed the diagnosis until they came to an agreement on how to describe the asthma and COVID which the computer finally accepted. “Yes ma’am, it worked. Sorry to have awakened you.”

A few hours later, Haley opened rounds. “Good morning everybody,” she said to grim faces. “Our coronavirus patient died in the night. This is bad.”

Faith, not having been in the hospital overnight, wrestled to get words out, “Why did she die? What killed her?”

“They couldn’t oxygenate her, and then she arrested. In other words, lung failure.” Ann answered.

“I talked to her the day before yesterday, and I sat and held her hand. I did her admission chart work and told her we would take care of her!” Faith’s voice trembled and cracked. “Then I saw her yesterday, when she looked terrible. I guess I shouldn’t be shocked, but I am.”

“We did take care of her,” Peggy said. “But her disease was bad and progressed rapidly. OK, what do we have here?”

“That sounded crass, Peggy,” Ann said. “But I know what you mean.”

Josh said, “Well, as you can imagine, we’ve got a lot of patients with minor issues we need to clear out of here. There are non-COVID colds, there’s a patient with contractions that isn’t in preterm labor, and a urinary tract infection that needs to be sent home. We don’t have anyone with anything serious.”

“This is a little annoying,” Haley said.

Peggy missed the point. “What’s annoying, Haley?”

“That we’ve got so many patients with minor issues that were not taken care of during the night. They should all be out of here already. It’s always like this, considering.”

Peggy still didn’t get it. “Considering what?”

“Our nighttime attending.”

“Who was it?”

“Yankton.”

“OK, what did he say about our death?”

“They couldn’t find him,” Haley said. “We aren’t sure he knows. Ann finally called Dr Beacham, and Ricky called you. Can’t you get fired for that?”

“You don’t talk to me about each patient,” Peggy said. “Why couldn’t you send them home? And if you couldn’t find him, why didn’t you send them home anyway?”

“He insists we talk to him about each one,” Josh said. “No other attending makes us do that.”

“We can get them out of here shortly,” Faith said, still staring at the floor. “We need to keep our unit clear so we can accommodate people who really need us.”

Peggy nodded. “Have we got ICU patients?”

Ann said, “Yes, both are in Medical ICU. We’re waiting on coronavirus detection tests on both.”

“Here we go,” Peggy said. She thought about the plagues in Europe in the Middle Ages.

Haley, Faith and Ann looked at each other.

“What?” Peggy asked, clueless again.

“I’m not at all comfortable with this,” Ricky boldly stated. “We may be about to enter our most critical time with our flat-out weakest attending!”

“Stop,” Peggy snapped. “Let’s take this conversation somewhere else.”

Like Keystone Cops, they made for the little conference room, shed the medical students, and shed their PPE.

Ricky took command again. “I don’t like this. We’re concerned we could have another death in the ICU today or tonight.”

“Should we talk to Dr Beacham?” Haley asked. “Ann, you’re our leader. Can you take us to Dr Beacham to talk?”

Josh next, “I second that.”

“I’m good with that,” Ricky said. “We need to have this conversation today.”

Peggy didn’t notice that Ann was on a call. “We need to talk to you. We’re concerned about a situation that is immediately upon us, and we need to have direction. Could the five of us — no, six of us — come talk to you? Or can you come to us?” There was a pause. “We’re in the little conference room in the hospital. We can come to you if you need us to.” There was another pause. “Yes, ma’am.” Another pause. “That should be fine. I’ll make that happen.” Ann glanced at each of them. “Yes, thank you. See you then.”

“OK!” Haley said. “Spill it!”

“We’re meeting at noon in the office building conference room. Be sure you’re there, Peggy.”

Peggy was still bewildered, “Is this situation that bad?”

Ricky said, “Oh, yeah, that bad.”

There was discussion of other patients and issues, followed by scattering to work they all wanted to have finished up before noon.

The impact of the previous night darkened Peggy’s vision and thickened the shadow over this morning. With a plodding gait, she made her way to his fellows’ closet desk. She slumped into her chair, opened a Diet Mountain Dew, logged onto her computer, and organized the tasks she needed to accomplish.

Faith entered, the frosted window acknowledging her soft spirit by emitting no sound. Josh followed, the two sitting in chairs halfway across the room, far exceeding the recommended six feet.

“We’re pregnant,” she announced.

“Congratulations. I assume this is your baby, Josh?”

“Yes. We think it’s a girl and we’re thinking her name is Cori.”

“That’s a nice name,” Peggy responded. “I’m glad it’s not Corona.”

“It’s not,” Faith said. “I had thought of this name before the pandemic, and it turns out my parents considered that name for my sister Natalie. I was only eleven years old at the time, so I don’t remember the discussion, but maybe that’s where it came from.”

Josh said, “We might tease some people about Corona, though. Like Haley.”

“She deserves it,” Peggy said.

“That’s what I said,” Faith agreed.

“So, how’s it going?” Peggy asked.

“Good so far,” she answered. “I haven’t felt her move yet, but I’m only fifteen weeks.”

“Yes. Glad to hear it. What do you think, Josh?”

“I’m so excited,” he said. “On one hand I am proud and excited, and on the other I know parenting is a life’s work. And to top that off, we’re bringing her into a world of COVID.”

Faith said, “We haven’t been telling anyone, except our parents. I met his parents on Facetime. He has a lawyer sister who helped me with my divorce. We’ve talked to my parents and sister several times. They met him when they came to help me move.”

Peggy changed the subject. “You have been learning amazing things that you discuss in rounds. I’m proud of you. Both of you.”

“I’ve been reading everything I can,” Faith said. “This pregnancy doesn’t help, though. Reading makes me so sleepy.”

“I’m completely familiar with that. At night, sometimes, I can hardly stay awake long enough to find where I left off the night before. It’s getting worse as I get older.”

“I’m trying to keep up,” Faith affirmed. “I want to become you, Ann, or Emily. I want to have that knowledge and judgment.”

“You’re on your way. Just keep going,” Peggy said.

“Can you believe Reyenne died?,” Josh said. “How does that happen?”

Peggy said, “It’s a bad virus. I didn’t think it was going to be, but it’s turning into a train wreck. I hope we learn quickly how to deal with it.”

“Me too,” Faith said. “I just can’t get past Reyenne.”

“I understand. In obstetrics we have occasional fetal or newborn deaths, but we almost never have maternal deaths. In fact, I have personally never had one.” Peggy added, “I don’t know how oncologists do it. Take care of a patient for years only to have them die.”

“How do we deal with this?” Josh asked.

“We have to be confident that we did all we could,” Peggy said. “We have to feel good about what we did, not what we could have done or should have done. A few months from now, when we know a lot more about this virus, we have to try not to kick ourselves for not doing what we then know might have saved her. We don’t know it now, and we don’t have it now.”

Faith’s face reflected her distress. “Not so easy. I keep thinking, what if it was Natalie?”

“Oh, no,” Peggy said. “It’s not easy. I don’t pretend it is. I keep thinking what if it was my wife, sister, nieces, or my brother-in-law who has serious lung issues?”

“It still could be,” Josh said. “I have a feeling this isn’t over. I’ve read that we’re going to have a short, violent wave followed by a longer, less dramatic wave before we have the medications and vaccines necessary to slow it down. Masks and isolation are only so good.”

“But that means it could be a year or two!” Faith said. “We’re in for a long haul. And I’m going to have a baby in the middle of it?”

“Thankfully,” Peggy said, “your baby is not at high risk of severe disease or death. You are, because of your pregnancy and your Humira, but not your baby.”

“I’ve read that too,” Josh said. “I hope that holds up as we learn more about it.”

“You’re at risk, Peggy,” Faith said. “Probably more than me.”

“I think so, too. Old, fat, and diabetic.” She snickered. “I’ll try to be careful, but I’m not scared of it.”

“I worry about her mom,” Josh said. “If I can use your words, Peggy, she’s fat, not as old, and diabetic.”

“Time will tell,” Faith said.

“Let’s just be careful, wear masks and face shields, wash our hands, and hope for the best.” Leaving the room, it was Josh who closed the door which quietly rattled at Peggy.

A few minutes shy of noon, the conference room had the whole obstetric team, a few with lunches. Low conversation ended abruptly when Emily entered. She took a seat at the end of the table, arranged a yellow legal pad, and unwrapped a sandwich. She made eye contact with Peggy.

“We are concerned about tonight,” Josh stated. “We are facing coronavirus patients, one of whom could well die tonight, with our weakest attending.”

“We need help with this,” Ann added. “I am not sure what we expect of you, but we are frankly scared of him in this current mess.”

“Are you thinking he’s not up to the task?”

Haley blurted, “He’s not up to the task.”

“Peggy, what do you have to say?” Emily asked.

“I’m only here to support them.” She knew Emily was informed about the night of the missing Brian.

Emily squirmed in her chair, ignored her sandwich, and then scribbled.

“Peggy, can you take call tonight?”

“Yes ma’am.”

“Thank you for coming, everybody. Thank you for bringing this to my attention and not just putting up with it. I promise I will take care of it. As you just heard, you have Dr Valdez for tonight.”

“I think we also need a long-term solution to this problem,” Josh said, then realized it might have been redundant.

“I recognize that,” she answered, apparently unannoyed. “I won’t let you down. If you’ll excuse me, I have pressing tasks at hand. Please stay, eat, and enjoy yourselves. Have a good night.”

She left the room. Peggy had to think about the magnitude of the problem Emily faced. An employee with substance abuse is always a nightmare, irrespective of which substance, how severe, how longstanding, or the rank and status of the individual. There were no nice ways to crawl through that briar patch.

That evening as Josh was leaving for home, a phone call came from Faith. “Don’t leave yet. I want to talk.”

“OK. Where are you?”

“I’m just finishing up with a delivery. I’ll be at the charting station in a few minutes. Where are you?”

“At the charting station.”

“I’ll be there.”

Ricky approached. “I’m glad we took care of Yankton. He’s a moron.”

“Yeah,” Josh agreed.

Ricky was scurrying off as Faith approached. “Do you think there is something going on with Brian?” she asked.

“What makes you ask that?” Josh asked. “What part of being a butt makes you think something is going on?”

“He is changing and changing rapidly. I can’t help thinking that I have contributed. After all, I dragged him to Albuquerque, then I kicked him out of his home, and now I have divorced him.”

“Wait, Faith. Stop thinking like that.” Josh said. “He came to Albuquerque, he didn’t have to do that. He had an affair, he didn’t have to do that. He has built venomous relationships with us, he could have been congenial.”

“I know.”

“But he is doing that, we aren’t,” Josh said. “That’s not on us or on you.”

“I just think he is changing, getting worse. I can’t help thinking something else is going on. Maybe the chlamydia woman, maybe work, maybe me and my divorce. Maybe he knows I’m pregnant.”

“How could he know? We haven’t told anyone.”

“You know how something like that could travel. Haley, someone in the office, something he saw at my house on one of his trips there. I guess he hasn’t been there recently enough for that.”

“I think he is struggling against his own demons.”

“I just hope he has a way to deal with them.” The change-of-subject face appeared. “We could ask Cori.”

“What’s up with Brian, Cori?” Josh said. “How should she know? Brian’s not her dad.”

“I know. I just like to talk to her.”

Josh kissed her. “I’m going home to bed.” It was the night-after-call for him.

“Yeah, see you tomorrow.”

Chapter 27

The frosted glass rattled. Peggy turned to see Brian almost dance across the floor.

“I had a good appointment with my orthopedic surgeon, and an interesting time in Pain Management Clinic.”

“Yeah?” Peggy said. “I would have thought that would rattle your cage and stir up your anger.”

“Well,” Brian said, “it did a little. But the way they approached it was opposite to what I had thought.”

“Tell me more.”

Brian scooted a chair up leaving the six feet open. “Dr Ballinger said that all I need for the knee is physical therapy, and I have an appointment. Pain management had me fill out some questionnaires, and then I took an MMPI. I thought that was outdated.”

“Minnesota Multiphasic Personality Inventory,” Peggy said. “I don’t think I’ve talked or heard about that since my anesthesiology residency. We did use it on patients in the pain clinic where patterns of results helped us focus on—”

“They said I have conversion reaction, but also that my depression scale is high. They say I am converting stress and life challenges into physical symptoms.”

“Yes, that happens, and it’s common. It can make new symptoms, or it can magnify minor symptoms you already have,” Peggy said. “As I remember, to make the diagnosis of conversion reaction, an elevated depression scale was required. What else did they say?”

“Dr Thompson has a plan,” Brian said.

“And—”

“I have to keep a log of all my medicines. I’m supposed to watch my log and keep reducing the Percocet until it’s gone. They told me to start on naproxen for pain, but take it twice a day whether I have pain or not. After I’m off the Percocet, they’ll give me suboxone to help me prevent relapses.”

“What did they say about your marijuana?”

“Nothing.”

“Because you didn’t tell them?”

Brian nodded, “I didn’t bring it up, but it’s on my drug screen. I haven’t had any for about a week, though. I think that’s good.”

“I think that’s good too. Are they going to do anything else?”

“I have counseling sessions.”

“How often?”

“Twice a week.”

“Did Emily say anything?”

Brian shook his head, “No. I haven’t talked to her or seen her.” He decided not to bring up being missing in action when the unit had its first COVID death. Peggy didn’t need to know everything.

“What else is happening?”

“I go to NA meetings,” Brian said, almost whispering. “I don’t like those. The people who come are low-lifes.”

“Is the group leader good?”

“I don’t know. I’ve only been to two meetings. He didn’t say much at either meeting.”

Peggy leaned back in her chair. “This is the most positive you have been. This sounds like you may have turned a corner. How do you feel about it?”

“I feel a lot better than a week ago, for sure. In another way, I can see that the mountain I have to climb is steep and high.”

“At least you see the mountain, Brian. That’s an amazing step forward. Did they start you on any medicines?”

“Yes,” Brian rolled his eyes. “I’m sorry. I forgot to mention them. One in the morning and one in the evening. I can already feel a buzz from the morning one, and the evening one makes me sleep like a baby.”

“Did you take one the night you were on call and the patient died?”

Brian skipped a beat when he realized Peggy knew about his eclipse, “That was my first one. It was probably not a good idea to be on call the first night I took my medicine, but I had seen the Pain Management Clinic that day and they sent the prescriptions to the Clinic Pharmacy, so I picked them up. I didn’t know it would affect me so dramatically or so soon.”

“Did you tell Emily that?”

“Yes.”

“I thought you hadn’t talked to her.”

“About the NA meetings and the counseling, no. We did talk about the night they couldn’t find me. I was in the call room. I don’t know why they didn’t come there.”

“Well, congratulations on your progress,” Peggy said. “Keep going.”

“I will, ma’am,” he said, and then the door rattled.

Brian thought it inexplicable that he felt the need to tell Peggy about each hurdle, but he felt good about it. It was a comfortable sounding block. If nothing else, it allowed him to think out loud in a safe place. Peggy never seemed judgmental, and she didn’t tattle.

Chapter 28

The phone rang. “Hello, Ricky.”

“Peggy, can you come to the lobby?”

“Yes, of course.”

“I’ve got a patient on a ventilator who’s rapidly getting worse, and we’re trying to keep up with her oxygenation. But that isn’t the problem. Her family is going nuts, and I’m not soothing them down. In fact, they are pushing my buttons.”

“I’ll be right there.”

Approaching a small waiting room just off the tall, glass-covered atrium, Peggy could hear an angry voice. A hospital security guard acknowledged her, and motioned for her to come in.

A tall, thin, pale man was standing just inside the waiting room door, yelling profanities at Ricky, who, in turn, was attempting to keep some distance.

“How did we get here? What’d you do to her that she got so sick? This virus ain’t supposed to make bad sickness at ‘er age! And you’re trying to blame this on ’er smokin’? And why cain’t I visit her?”

Peggy introduced herself to the tall thin man.

“I’m her husband Justin. I don’t understand this. I want to take her to another hospital.”

“Well, Justin, here’s where we are,” Peggy began, calmly. “Nobody has control over this virus, nobody knows much about how the virus behaves, and nobody has a treatment that works. It’s less serious for most younger folks, but both smoking and pregnancy make her more fragile. We don’t want you to visit her because if you’re not infected, you could get infected.”

“This twit,” he motioned to Ricky, “told me she could die, since she’s been sick only a day, and is so bad so quick. Why can’t you save her with some antib’otics? That’s what we came for. We just wanted some antib’otics.” He turned to face Peggy directly, moving his arms.

The security guard grabbed Justin’s right arm.

“Justin, calm down. If you assault one of our personnel, I’ll escort you out of the building, and you will wind up downtown in a cell.”

“Take your hand off my arm,” Justin yelled at the guard.

“I will! As soon as you calm down. I won’t let you harm anybody.”

“But they got my wife sick. When we came, she just had a cold. I wanna be with her.”

“That’s sort of true,” Ricky said, exhibiting courage. “Coronavirus is a cold virus, but a real bad ass. In this case, it’s made her so sick so fast, that we thought you should know that we view this as a bad sign.”

Justin shot back, “Horse buns. Y’all are covering up for having made her sick. Did you do something wrong?”

“No,” Peggy said. “She has a bad disease. It’s killing a lot of Americans. Not just old biddies like me, but many others who have medical problems, including pregnancy, putting her in grave danger.”

“We’re giving her everything we can to help her,” Ricky added. He looked at Peggy. “Dr Valdez, she’s getting hydroxychloroquine, theophylline, erythromycin as a substitute for azithromycin, and we’re using one hundred percent oxygen with thirty-five centimeters of PEEP.”

“What’s that mean? What’s that mean!” Justin shouted. The guard was still holding Justin’s right arm.

“He just listed all the medications he’s giving and all the ventilator settings he’s using to try to save her life. He’s panicked that we’re at full throttle and losing ground.” Peggy said calmly.

“Then I want to take her somewhere they can save her.” This time Justin’s voice was lower, emulating a deflating tire. “I’m gonna take her to Presbyterian.”

Peggy let him settle down a little more. “We’ll do the best we can. There is nowhere to send her. All the hospitals are full. Dallas, Denver, and Phoenix are too far away. I don’t think she would live through moving.”

“God,” Justin mumbled. “So, what do we do? Just sit here and watch her die?”

The officer let Justin’s arm go, and pulled up a chair.

“Or get well on her own. We’re doing all we can. There isn’t anything left. Now it’s up to her.” This seemed to get through to Justin.

“Her mom can’t come. There are no flights that’ll get her here in 24 hours.” Justin accepted a chair Peggy offered. “Is there anything else we can give her?”

“No. We’re giving her everything we have.” Peggy just wanted to emit calm-sounding words.

Justin sat in the chair, put his elbows on his knees, and his face in his hands. His chest shook.

Ricky put his gloved hand on Justin’s gown-covered shoulder. “Is there anyone else we can call?”

He didn’t answer.

“Has Justin been tested?” Peggy asked Ricky.

“Yes, they both have. I don’t have results, but it’s obvious she has it.”

Justin was joined by his parents, who had been sitting silently in the corner. Peggy and Ricky left Justin and his parents huddling together. The security guard nodded as they left.

“Peggy, if she dies, I’m going to melt,” Ricky said, misty-eyed.

“You’d better get in the freezer, then.” She watched to see if Ricky caught the metaphor. “We don’t want any melting around here. This may not end well.”

“I get it.” His face was ashen.

Peggy put her hand on Ricky’s shoulder, “You should feel good about what you have done for her. You gave her the best chance of survival you can. Your erythromycin idea to substitute for azithromycin was clever. If she dies, are we going to deliver the baby?”

“What? Seriously? I suppose we should, since she’s only a few weeks from her due date. I hadn’t thought of that. I don’t know how to do that.”

“A cesarean section, on her bed, right where she is. You won’t need sterile conditions, you won’t need to sew up all the layers, just get the baby out. Leave the placenta behind, and close the skin. All you’ll need is a scalpel, a cord clamp, and a skin stapler.”

“God, Peggy, no kidding?”

“Yes, just think. When you do this, it is all about the baby. You don’t need to do all the things we do to help the mother recover and heal. Just get the baby out and leave it at that.”

“OK. I’d better get Labor and Delivery ready for that. I might call Ann to help me.”

Ricky bumped elbows with Peggy and took off. Peggy went back in to check on Justin.

She found Justin still sitting in a chair, holding his mother’s hand. Peggy delicately put her hand on Justin’s shoulder. When he saw Peggy, he stood.

“I’m so sad,” Justin murmured. “I can’t believe this has happened. Is it because of her smoking and her pregnancy?”

“Partly. It’s because of this evil new virus. We’re seeing severe illness in pregnancy with no other health problems. I’m sorry she’s so sensitive to it.”

Peggy was momentarily distracted by a text.

“She’s dyin’ ain’t she,” Justin whispered.

“I’m afraid so,” Peggy said. “But I think Ricky can save your baby.”

“How does that happen?”

“She has a cesarean section right about now.”

“I want to be with Jenessa. I should hold her hand.” Justin was panting and sobbing.

Another text arrived. The baby had been born alive, doing well, and Ricky and Ann were “recovering,” the word Ricky had used. Peggy understood. The trembling doesn’t seem to come while you are working on a terrifying case, but in the first ten minutes after it’s over.

“There you are, Justin, your son was just born.”

“Did she die?”

“Yes,” Peggy said, “but your baby’s alive.”

Justin looked scrambled. “I have four kids but no wife.”

“Yes.”

“I want to see my son,” he said. “She had to die alone! Nobody should die alone.” They stood together, saying nothing.

“Nobody should die alone,” Peggy repeated.

“I need to call her mom. I’m not sure what I’m gonna say.”

“Tell it like it is. You have a son, and she has a grandson.” Peggy answered, making it sound simple. Not.

Justin pulled out his cell phone, punched buttons, and put it to his ear.

“Mum, it’s Justin.” He choked up.

Peggy heard “No, no, no,” on the other end. There was no more conversation. Peggy just stood still, her presence more important than her words. When the call ended, he accompanied Justin back to the waiting room to join his parents. No words were needed to convey what had happened. Two grandparents’ faces relayed surprise when they were told baby had been saved.

Washing his hands and face in the bathroom near the ICU, Peggy looked in the mirror. Ricky barged in the bathroom, sweat rolling off his face, bright red PPE marks across his cheeks, chin, and nose. “I can’t believe what I just did.”

“A true cesarean,” Peggy finished. “Congratulations? Or maybe it should be my sympathy?”

“I’m sorry.”

“I understand. Nobody wants to have to do one. But what you did was save the life of a little boy. You did a great job.”

“But I killed a woman.”

“No, you didn’t. The virus killed the woman. You prevented the virus from also killing the baby. Be sure to focus on the bright side.”

“That’s hard.” The rest of the conversation flowed by eye contact through the mirror.

Chapter 29

“I don’t think I want to do this,” Brian said, situating himself in front of Peggy on a rolling chair.

“What don’t you want to do?” Peggy asked.

Brian took a deep breath. “I don’t want to do anything. I don’t want to stop my opiates, I want my nightly weed, I don’t want to take this medicine, and I don’t want to work here.”

“That sounds like a step backwards.”

“But the expectation of me is insurmountable.”

“Hmm.”

“I don’t know if it’s worth it.”

“What choice do you have?”

“Just keep going the way I am.”

“Until JD and Emily terminate you? Until you fail another board exam? Until you alienate more friends and coworkers? Where does that end?”

“I don’t know. Just let it run where it runs.”

“Let’s go back to lymphoma and cancer of the pancreas.”

“Why does it have to be lymphoma and cancer of the pancreas?”

“Because you have about the same chance of dying. We know patients that are not treated are more likely to die.”

“How do you know all this stuff?”

“I read. I didn’t know any of it a month ago. Anything I don’t think I know enough about, I read.” Peggy reached for a few sheets of paper stapled together. “Here. This is what I found out about depression and substance abuse. The article is mostly about opiates. It was eye-opening for me. I didn’t know the prognosis was this grim.”

“I don’t see the similarity. How does this kill me?”

“Suicide or overdose.”

“I have never thought about suicide, I don’t know how I would do it, and I don’t think I could.”

“That’s a good thing. But it’s possible to do it by accident.”

“So, why’s this threatening?”

“Because so many opiate dependent patients do it, and most of them do it either impulsively or accidentally. It seems that families and caregivers rarely see it coming.”

“Is that what this says?” Brian flipped one of the pages of the little bundle.

“Yes, but maybe not in so many words. Just that the prognosis is surprisingly poorer than one would imagine, recurrence is common, and that death is unexpected. Like cancer of the pancreas.”

“I came to tell you that my Pain Management doctor gave me another medicine.”

“Suboxone?”

“Yes.”

“You told me. Something that prevents you from getting the high, the euphoria, of the opiates. It also makes it a little harder to overdose. Did you start it yet?”

“No. I am still taking some Percocet.”

“When did they tell you to start it?”

“When I have been Percocet free for a week.”

“OK. What else is going on?”

“Nothing.”

“You know about Elizabeth Kubler-Ross’s five steps of death and dying, right?”

“Yes, sort of. Denial, anger, bargaining, depression, acceptance. There, I guess I did remember.”

“Congratulations. Where do you think you are?”

“I am not dead or dying.”

“What does that tell you?”

Brian didn’t answer.

“Denial?”

“But I am denying something I am not sure is facing me.”

“What if this was lymphoma or cancer of the pancreas? Wouldn’t you wonder if they had interpreted the biopsy right? Wouldn’t you wonder if they had mislabeled the specimen and that the cancer was someone else’s?”

“Yes. I don’t think what they told me is correct.”

“So, you have some soul searching to do.”

“Between you and my Pain Management crew, I am about to go nuts.”

“You realize that is half the battle, right? Once you honestly, in your deepest soul, are convinced that this is a problem, you can tackle it with vigor. Only you can enter and follow the treatment. Only you can allow yourself to be treated. Only you can climb this mountain.”

“But then what?”

“Take up life and enjoy it. Dive into your career.”

Brian didn’t say anything, visions of mountains, treatments, trials, and tribulations swirling in his head. How would this end? When would he be free of it? Brian stood. “Thanks.” With no more than that, he left the room.

The window didn’t rattle.

Chapter 30

Peggy was relaxing in the call room when her phone displayed Ann as the caller. “Peggy, the patient that Faith brought up from the Emergency Department, Melanie Forsythe, has become extremely difficult to ventilate as well as oxygenate. We’re using insanely high peak inspiratory pressures, insanely high PEEP, and one hundred percent oxygen. With that we only have about eighty percent pulse ox, and a blood gas shows a carbon dioxide too high for pregnancy. I’m about out of options.”

“Yes, Ann,” he replied.

“She has an insanely elevated d-dimer and almost no white blood cells, both terrible predictors. I’m meeting with the family in the main lobby. Do you think you could join us?”

“Absolutely. I’ll be right there. Are you insanely OK?”

“No.”

Sunny skies in the lobby atrium belied the gravity of the immediate problem. Two trips to this place for the same reason in four days was repugnant.

Ann introduced Peggy, “This is Greg Houston, father of the baby, Frank and Brenda Forsythe, Melanie’s parents.” The faces were grim. Brenda was seated with the others standing. Ann had masks on all of them.

Ann addressed the family, “Dr Valdez can help me.”

“What do we know so far?” Peggy opened the discussion.

Frank, the patient’s father, said, “Dr McCauley told us that her lungs have rapidly deteriorated, and that she might not survive.” Tears were running down his cheeks. “No one should outlive their child.” This yanked hard on Peggy’s heartstrings, as she thought of her wife, niece, and her extended family in Crystal Springs.

“Yes, no one should outlive their child. Coronavirus causes swelling and fluid in the tiniest airways in the lung. In her case it’s bad enough to occlude them. This prevents moving air in and out and keeps oxygen from getting into the blood.”

“Dr McCauley told my wife, Brenda, that there was nothing else to do.” He struggled with the rest of the thought, “If her heart stops, they won’t do anything because even if she restarts, it will stop again and again.”

Brenda was sitting in a chair holding her face in her hands.

“Yes. Sadly, we can’t fix the problem. She has run out of the kind of white blood cells she needs to fight the infection and her lungs are failing her.”

“Is this because of the pregnancy?” he asked.

“Well, it’s because of the virus. Pregnancy makes things worse.”

Frank was frustrated. “How did this happen? Where did she get this?”

“We don’t know,” Ann answered.

“How can we find out?”

Peggy let Ann continue, admiring the job he was doing. “She got it between two and eleven days ago, I expect the shorter because of how fast she has gotten sick. She must have come in close contact with someone who had it. We think it can be transmitted from someone before they know they are infected.”

“For her sake, it’s not important for us to know,” Peggy said.

Brenda stood and looked at the group. “Are you sure she will die today?”

Ann sounded bold. “Yes. Her pulse ox is down to sixty-five percent. It might be in the next hour.”

Frank’s mouth popped open. “The next hour?”

“Yes,” Peggy said. In the next few minutes.

“She started a little cough yesterday,” Brenda observed. “How can she die today?”

As Brenda wheezed out the words, Ann looked down at a text message, and told Peggy with eye contact.

“Brenda,” Peggy softly spoke to her, “She’s gone.”

“My little girl is gone,” she spoke, one word at a time between sobs. “My grand-baby is gone, too!”

“Yes,” Ann said, whispering because she had lost her voice. “I’m sorry.”

“You can sit here as long as you like,” Peggy offered.

Brenda looked up, “No. I want to go. You guys need the ventilator.”

“What?” Peggy gasped.

“I know you need the ventilator. I heard that last night on the news.” She was sobbing and moving toward the door.

“Not only couldn’t the family see their daughter, they couldn’t hold her hand as she died, and they can’t visit her now. That’s cruel.” Ann said.

“Yes.”

Peggy walked with Ann to the ICU where Faith was sitting on the bench outside the door, her face in her hands. As they approached, she looked up, sweat, PPE marks, freckles, and all. “I don’t know if I can stand this,” she said.

“I don’t want to suggest that any of this is easy or that this isn’t the scourge of the century,” she said, “but I know you better than to think you will succumb to this. Of all the people in this medical center, not only do you have the compassion, but you have the personal strength it takes to weather a storm like this. But I know exactly what you mean. Sometimes you want to wake up from a bad dream, which doesn’t happen.”

“That’s what this is, Peggy. A bad dream. Every time something bad happens to one of our patients, I can’t help but go into a tailspin worrying about Josh and Cori.”

“Cori?”

“My baby.”

“Cori.”

“I just wish I knew that this is going to turn out OK, Peggy. Do you think it will?”

“Yes.”

“How do you know?”

“You are strong. Josh is strong. Cori has everything going for her. We are seeing the worst of the worst. We aren’t seeing all the ones who don’t know they’re sick or who are only mildly ill. We see the ones that need serious intervention. We get a slanted view.”

“I’ve never seen someone die before,” Faith confessed. “It wasn’t ugly looking, but it was ugly feeling.”

“Yes.”

She stood from the bench. “I need to get some of this work done. Thanks for talking.” She disappeared into a bathroom.

The way she walked away exuded strength and determination hiding grief and the injury. Peggy admired her stamina, her honesty, and her fortitude. She was going to become a bastion of the profession.

Chapter 31

“Can you believe how fast she died?” Faith asked, sitting next to Josh at the charting station and leaning on his shoulder. “It was less than twenty-four hours from when she had symptoms to when we couldn’t oxygenate her. That’s amazing. What else does that so fast?”

Josh had no answer. “I don’t know. Bacterial sepsis doesn’t. Maybe some poisonings and chemical weapons. Botulism?”

“I can’t believe this. That means any one of us could be working today and in a casket tomorrow.”

“I try not to think of that, like I don’t think about the dump truck on I-40 with no brakes.”

“I suppose,” she said. “It’s just that this hammers it home. Then others come in, get a couple days of oxygen, and go home. And there are some who don’t even know they have it?”

“That’s what everybody is saying,” Josh said. “especially children. I guess there are lots of children who get this and don’t know. I read that it is also true of scores of other viruses kids pass around. Except nobody dies from those.”

“Every time I think I understand medicine it throws me an intellectual curve ball.”

“Which is why everybody is arguing about facts about this virus,” he said. “You can get it from surfaces, you can’t get it from surfaces. Sunlight kills it, sunlight doesn’t kill it. Masks work, masks don’t work. Hydroxychloroquine works, hydroxychloroquine doesn’t work. Remdesivir with be a game changer, remdesivir doesn’t work. I’ll bet the experts will be pontificating and changing their minds for a year. And who’s to say that the virus we have in New Mexico will behave the same way as the virus in Miami, Anchorage, or Los Angeles? Or Jakarta!”

“I have thought of that,” Faith said. “I wonder if we will look back on this and laugh at the way we muddled through it, the way Peggy talks about AIDS and hepatitis C.”

“I think we will. But in a decade, we will know so much about this that we will wonder why we couldn’t do a better job. It’s not that we don’t want to, we just don’t know what to do. What are we doing that will turn out to be a good thing? And what are we doing that we later learn harms the patients.”

“It’s scary.”

Josh took a deep breath. “There is something even scarier.”

Her eyes flashed open and snapped to his face, “What?”

“What if this is a biologic weapon? What if this is man-made? What if someone figured out how to hook a virulent coronavirus to some molecule that allows for fast human-to-human propagation? Or worse, figured out how to make an innocuous virus that transmits well into one that is virulent and lethal.”

“Jeez, Josh! Shut up! Don’t think about that and don’t say it.”

He tried to make her change-the-subject face. “What if Cori has red hair?”

“Wait, what? Did you just change the subject?”

“I’m emulating you.”

“I don’t do that.”

He laughed. “No. Not at all. Never. It’s like my brain trips over a curb every time you do it. Anyway, what if she has red hair?”

“Where would that have come from?”

“My sister, my mom when she was young, my uncle, Haley.” None of those were true.

“We’re not related to Haley.”

“Are you sure?”

“Yes. You’re related to Ricky. Ricky doesn’t have red hair. I thought black hair was dominant.”

“It is supposed to be. But what if the baby isn’t yours.”

“The blond joke again?” She leaned over and kissed him on the cheek. “I’m assuming the baby is mine. I don’t know how it could be otherwise.”

“Time will tell. But I keep thinking about it. I saw a curly-headed girl with light blue eyes in an ad on TV and wondered if I was looking at Cori.”

Faith sneered. “You know what I look like, right? I doubt both the red hair and the blue eyes. Because of you, curly hair’s not impossible.”

“I hope she likes puzzles and board games.”

“You might want to find a class on how to dress Barbie and Ken.”

“You Tube.” Josh felt warm inside. “I don’t care what she likes. I will like it too.”

“Me too,” she muttered snuggling up to him. “I can’t wait until I can feel her move.”

“We need a crib.”

“Where is she going to sleep?”

Josh looked around as if he were home in the bedroom. “In our bedroom at first. Then later in the study. There’s room for the roll-top in the living room.”

“It would show off better there.”

Josh snickered. “Like we’ll be having guests. At the rate the virus is going, we might be stuck here for a long time.”

“I’m OK with that,” she said, giving him the melting look he loved. “Mostly it is how we are living now. Who has time for guests? And after Cori comes, we will be even more time-constrained.”

“I can’t wait.”

Chapter 32

Josh awoke, laying on his right side, feeling hot and sweaty. He felt Faith breathing fire on his shoulder, her burning hot body tightly spooning. Before he could turn to look at her, she shivered, and his gut wrenched.

“I’m freezing,” she whispered.

“You’re hot as fire!” he said. “Let me get you a couple Tylenol.”

He was back in a flash. She took the Tylenol, drank a little of the water, and he tucked her in with the comforter and the blanket from the bed folded in half.

He laid back down, hoping to get some sleep before a call day. In two hours, he awoke to her shivering again. Since he had only given her two regular strength Tylenol, he gave her two more.

“Thank you,” she whispered. He looked at her eyes, red and watery.

He settled back to bed only to awaken to her groaning. “I have to go to the bathroom, but I’m so stiff it hurts to move.”

He looked at the bedside clock. Five thirty. Almost time to get up. She came back from the bathroom, sweaty. “Good, maybe your fever has broken.” He gave her more Tylenol, offered her a dry nightgown, and tucked her in using towels.

Before he knew it, it was seven fifteen, when rounds should already have started. He had never been late before. The thought quickly vanished as she shivered and moaned.

He found Gatorade in the refrigerator but had to coax her to drink it.

“My arms and legs hurt so bad,” she said. “It’s almost painful to breathe.”

Compelled to reveal his fear, he muttered, “Are you thinking what I’m thinking?”

“COVID?” she answered.

He nodded. She didn’t protest. She didn’t feel as hot, so he left her under her piles of covers and took a shower.

Health officials were asking patients to call before coming to the emergency department, so Josh made the call. After numerous trips there to evaluate patients who might need obstetric or gynecologic admission, he had several numbers in his cell phone. He dialed the one to the charting station.

“Emergency Department, Ian.” Both Faith and Josh knew Ian well.

“Ian, Josh Menkowicz.”

“Josh, what’s up?”

“Faith is sick.”

“Uh-oh.”

“Yeah. She had chills early this morning, and now has muscle aches. I don’t have a thermometer, but she was burning hot after midnight. She got better with three doses of Tylenol, but now she says the muscle aches are severe. She has psoriatic arthritis on Humira. Do I need to bring her? Oh, and she’s sixteen weeks pregnant.”

“Would you guys admit her?” Ian asked.

“Only if she needs oxygen.”

“Yeah, bring her. Text me when you’re here.”

“Faith,” Josh whispered, touching her shoulder to arouse her. “I need to take you to the ED so we can test you for COVID and measure your pulse ox.”

She looked at him for a few seconds as if he had offered anchovy ice cream, then popped her head up to look at the clock. “Is it already after eight? I’m so sore.”

Josh found sweatpants, matching sweatshirt, bra, socks, and tennis shoes and helped her put them on. She struggled with each item, and he encouraged her to drink Gatorade in between garments.

“You like orange,” he encouraged, hoping she would drink more.

“I can’t tell what flavor it is.”

He helped her totter to the bathroom. She brushed her teeth, while he combed her hair, and tied up a ponytail.

“Jeez, who is that?” she asked the mirror.

He offered more liquids, “I can’t do that stuff.” She stuck her tongue out.

Crouched over with her arms folded in front of her, he led her shivering to the front door. Even though it wasn’t cold outside, he grabbed a jacket and put it over her.

The flight of steps was arduous, requiring two stops to complete, and he could tell the bright sunshine was miserable for her. His car was nearby, and he prodded her into the passenger seat. She leaned back against the headrest and closed her eyes. He drove through morning traffic to the emergency entrance.

Inside, she was quickly placed in a room, and someone in full PPE took her temperature, blood pressure, and pulse. A pulse ox probe was placed on her finger, a swab went in her throat, and another swab deep in her nose.

“That was ugly.”

The nurse agreed. “Isn’t it? Sorry.”

In record time, Ian, in PPE, came to talk to her. “You have a high fever. We’ll test you for influenza, strep, and coronavirus. Your pulse ox is marginal. In light of the pregnancy, I think you should use a low dose of oxygen.”

“OK,” Faith whispered. “Where’s Josh?”

“We don’t want him to come in. We’ll test him and put him in PPE later.”

A respiratory therapy tech entered the room, also in PPE, and attached little tubes in Faith’s nose, hooked it to the wall, and started the flow of oxygen. The tech had no more than left when Ann entered the room.

“Good morning,” Ann said. “I heard you feel like death warmed over.”

“I do.”

“We’ll pump you full of Tylenol, find you a room, and take good care of you.”

“And Cori.”

“Cori?” Ann smiled. “Good name.”

Josh headed for the small conference room where he planted himself in a chair. His heart was pounding. The impact of the last few hours now landed on his shoulders, and he took stock of what had happened and the implications.

He dialed Natalie. “Hi, Josh. What’s up?”

“Faith is sick,” he wheezed. “After midnight she woke me up and had a high fever. She was burning up. I gave her some Tylenol, but in a few hours she was hot again. I gave her more Tylenol and Gatorade. By this morning, she was stiff and achy, and said she couldn’t taste her Gatorade. We brought her to the hospital, and she’s on oxygen.”

“Oh, Josh,” Nat blubbered. “Is she going to die?”

“I hope not. The good news is that she isn’t progressing the way the three patients we had who died, but the bad news is that she is on Humira and she’s pregnant.”

“What does the Humira have to do with it?”

“It is an immunosuppressant, so it might make her body not fight as hard.”

“Is pregnancy bad with COVID?”

“Yes. Pregnant patients are more susceptible to severe disease.”

“But I thought her age group rarely had trouble.”

“Yes. But she’s pregnant and on Humira.”

“So, what happens next?”

“We wait and see. We don’t have any treatments that work, we don’t know enough about the virus to actually know what to do, and unlike other diseases we don’t have a way to know where this leads.”

“This is bad news, Josh,” she said.

“Can you tell your parents?”

“Yes. They aren’t here right now, but I can call Dad.”

“You can call me back if you want to. Faith has her phone. I’m warning you, though, she sounds terrible when she talks, and she coughs a lot.”

“OK. Can we come visit her?”

“No. We don’t want you to get infected. And that is super true of your mom.”

“Oh yeah. Fat and diabetic. I remember.”

“I’ll keep you up to date, Nat.”

“OK. Bye Josh.” He heard her start to cry as she ended the call.

Chapter 33

She startled him when she awoke and spoke. “Hi.”

“There you are. Did you sleep well?”

“No. I had stupid scary dreams,” Faith’s scratchy voice said. “Then I realized where I was, and then the dreams came back.”

Josh handed her a Styrofoam cup with ice water which she took through a straw. “This is really scary, Josh. How does this end? My muscles all hurt, if I take a deep breath I cough my head off, and the chills are the pits.”

“I understand. You have to get it together and get well.”

“How do I do that? So far, it isn’t working.”

A nurse arrived with some medicines in a little plastic cup. Faith pitched them in her mouth and washed them down with more water from the cup Josh held. “There’s Tylenol in that, so in an hour I’m going to be sweaty and burning up.”

“They said that so far, that’s keeping your temperature down,” Josh said, “which is important for Cori.”

Josh’s heart warmed when he saw the mischievous look on her face. “Who? I don’t think I know her.”

“Some little blue-eyed, red-headed girl who needs her mommy to get well.”

Faith laughed and grimaced. “Josh, don’t make me laugh.” Without a break, she said, “Hello, Peggy. Why are you here?”

“I had a thought. Do you think you could tolerate a CPAP mask?”

“I don’t know. What’s that?”

“It’s a mask you strap to your face. Normally it’s used for obstructive sleep apnea, like in fat, old women like me.” She chuckled. “I sleep with one every night.”

“Do you think it will help me?”

“I don’t know. But we could try it. It might make it easier for you to breathe. It keeps some air pressure on you all the time.”

She nodded. “I’ll try it. Will you help me and stay with me until we know?”

“Yes. It will only take a few minutes to know if this is a dumb idea.”

“OK. Let’s do it!”

She plugged the machine into the wall outlet, entered settings, and handed the mask to Faith.

Peggy placed the mask on her face verifying the size. “Do you think the mask will freak you out?”

Faith laughed out loud, followed by a fit of coughing. “More than coronavirus?” Cough. “I don’t think so.” Cough.

They had to wait for her to stop coughing to continue. Peggy hooked the hose to the machine and the mask, then helped her put it on, adjusting the straps until there was a good seal, making it comfortable on her face, and connecting the oxygen. They both watched the pulse ox reading hold steady.

“That does feel better,” Faith said. “It’s so good I might be able to sleep.”

“Sleep would be good. You need rest so you can fight this off.”

“How do you manage a pillow?”

Peggy chuckled. “You fluff it, adjust it, and turn it until it’s comfortable. It’s hard at first, but once you know how you like it, it gets easier.”

“Any way it sits on my face is OK?”

“Yes,” Peggy said. “If there’s a good seal, it’s working.”

“I think I like this.” Faith closed her eyes.

Peggy turned to go. “Sleep well.”

Josh said, “Thanks Peggy.”

“Peggy, I’m really scared,” Faith’s hollow voice came through the mask.

“We’ll take good care of you, Faith,” Peggy said. “I promise.”

“Peggy! That’s what I told Reyenne!”

Josh said, “Don’t think like that Faith. You’re doing so much better than Reyenne did.”

“I’m still scared.”

“We’ll be right here,” Josh wheezed.

“Can you call my parents?”

“I did. Well, I talked to Natalie.”

“That’s good.”

“Think about the bench near the little stone house on Sandia Peak. Feel the wind on your face, listen to the Douglass Firs whisper, and watch the birds flit around. Check out the marmot and the chipmunks.”

“That was really nice, Josh. That was an amazing day.” Faith drifted off. Josh kissed her cheek and left.

Chapter 34

“You look better, Brian. Great.”

“Oh, man, what a trip. I have never done anything that ugly.”

“So how does it feel now?”

“In a way, I feel better. But lots of things hurt, especially my knee. I had a horrible headache yesterday.”

“Gosh, Brian, what a hurdle you have leapt over. Congratulations. Now you have proved the strength you have and the strength you can count on to go forward.” Peggy wasn’t entirely sure that a complete opiate withdrawal had occurred, but for the moment, she decided to go with the flow.

“But my past is the pits. I have put my career in jeopardy, I have wrecked my marriage beyond recovery, and I don’t have any personal elements of my life left.”

“Stolen by opiates.”

“I used to think stolen by my knee.”

“Stolen by opiates. Maybe the knee what got you to opiates, but opiates are the villain.”

“Interesting personalization of opiates.”

“They will be your villain for the rest of your life.”

“That’s what Pain Management says. They say that I will be recovering and never recovered.”

“It will be a life-long struggle. Like with everything else in life, you will have good times and bad times.”

Brian’s face looked mournful. Then he said, “Villain.”

“Maybe opponent?”

“I like villain. I can see a tall figure in a black hood and cape with glowing, yellow eyes.”

“That works,” Peggy said.

“When I look around, it seems like no one but me has a villain like I do.”

“Aren’t you going to group meetings?”

“Yes.”

“That’s a whole roomful of folks who have big villains, and I bet there are some that have villains larger than yours, or have several of them.”

“There are some vets that have physical limitations as well as opiates.”

“Some have alcohol, gambling, all the rest.”

“Pain Management gave me a couple of books to read. But they are very unpleasant. Somehow, reading about someone else’s struggle with this doesn’t help me. I know I need to look forward, but some of the stupid things some of those people look forward to disgust me.”

“You don’t have to look forward to the same things. Whatever works for them works for them. You must find what works for you.”

“OK.” Brian said. “It’s hard.”

“Hard shouldn’t bother you. You went to college, medical school, did an obstetric residency, completed a fellowship, and now you are starting as a faculty member. Those are all hard. You should be pretty used to hard.”

“Those don’t seem to measure up to the hard I feel now. Those other hard things came to an end and are behind me. I don’t remember any obstacle in my past being this tall.”

“There will be some physical as well as psychological tricks your villain plays. Villains don’t play fair.”

“I hadn’t thought about that.” Brian sat a few minutes. “I’m going to get going. Thanks for talking to me.”

“No problem. Keep plugging. Just keep chipping away until you get the job done. Don’t set a time limit. Just keep working.”

“Thanks.” The glass in the door rattled.

Chapter 35

“Hey!” Ricky answered the phone.

“I’m scared to death.”

“Who isn’t?”

“Faith is the love of my life,” Josh said. “This girl claimed my heart the first time I saw her. I think she’s drop-dead gorgeous, she has a sharp mind, and she has such a loving heart.”

“You’ve been gaga over her forever.”

Josh didn’t notice the levity. “I can’t imagine what I would do if I lost her now!” Tears were running down his cheeks as he drooped in the chair. “That means I would lose Cori too.”

“You know this is getting to me too. I had to do a cesarean section to save the baby of a woman dying from COVID.” Josh heard the creak of his recliner.

“I know, I heard.”

“It’s eerie that I took a baby out of a woman and then just left her. I had a baby but didn’t think about the woman. Usually, we make sure she has pain relief, something to eat and drink, and that her vital signs are stable. I didn’t do any of that. I just sat and held the baby for a long time.”

“There’s nothing about this pandemic that is usual, Ricky. I just hope it doesn’t get more unusual for Faith.”

“If it’s any consolation, Josh, she’s not progressing much, so that’s good.”

“This is the worst thing that could happen. I don’t want her sick. I want her and Cori to stay in my life. I knew this whole thing was too good to be true.”

“I get that. I don’t know what to say.”

“In some ways, Faith looks a little like Reyenne. Her eyes and her color. This is a horror movie.”

“Don’t get too far ahead, Josh. Keep your cool. She needs you to keep your cool, and you need you to keep your cool.”

“I’m trying.”

“Have you talked to your family?”

“Yes. Not to my parents much, but to my sister often. I talked to Faith’s dad, Jim, and to her sister, Natalie. They’re all freaking out. You’re my only sane sounding board.”

“Let’s keep it that way.”

Josh took a deep breath. “It’s good I tested positive. I mean, I don’t want to be sick either. But it means I can visit her, which most other family members are not allowed to do. She is even pleasant in this mess she’s in.”

“I’ve come to enjoy and admire her,” Ricky said. “She’s bright, funny, and like you say, beautiful. Her compassion shows.”

“I think she will make an amazing doctor,” Josh said. “I hope I can measure up. She wants to do maternal-fetal medicine.”

“I can believe that. This seems to be her niche."

Josh stumbled over the next part. "First, she has to survive COVID. Then, she has to survive without any residual effects, which I am reading some patients get. I’m terrified that one of the two outcomes could ruin all this. What if Cori doesn’t survive this?”

Ricky was quiet for a few seconds. “I think they both have a good chance of survival like a number of others we’ve had. We haven’t had a fetal death, so that doesn’t seem to be a problem. From the information Haley has, no one is talking about fetal demise without maternal demise.”

Josh’s heart jumped. “I don’t know what I’ll do if she dies.”

“I don’t either. Think of the birthday party. I’m still amazed by that.”

“Everybody loves her. I love her.” Josh sighed again.

“We have to be calm for her,” Ricky said. “I have to admit, I find that hard. I have not been right since I held Reyenne’s hand while she died. There was nothing to do and I felt totally worthless. And we had Yankton as the attending, who we couldn’t even find. I felt hung out to dry.”

Josh somehow stumbled upon some levity. “You are totally worthless.”

“OK,” Ricky snorted. “It sounds like we have solved all the world’s problems.”

“Talk to you later. Thanks, Ricky.”

Chapter 36

Brian knew he needed to talk. Peggy was not the ideal person, but it was someone who could be accessed without an appointment in late morning. Brian’s office had finished early, thankfully, and he entered the fellows’ closet, rattling the window.

“Good morning, Brian,” Peggy said. “What’s on your mind?”

“Faith is sick.”

“Tell me about it. We are all stunned and terrified.”

“I’m stunned. Why are you guys terrified?”

Because of her immunosuppression.” Peggy said. “Between pregnancy and Humira, we don’t know what we are facing.”

“And we’ve had deaths.”

“Yes sir, three,” she said. “Considering I had never had a maternal death in forty years of practice, this is daunting. I am even having bad dreams.”

“Do you think she will survive?”

“I hope. At least she didn’t crash the first day like two others. She’s gradually getting worse, but slowly enough that I hope she will turn this around soon.”

Brian’s hand trembled as he scratched his ear, and he felt his heart in his chest. “We didn’t think this epidemic was going to amount to much, and now it has become historic. Somebody said we could have two million deaths.”

“I hope we don’t get to that.”

“What about Faith terrifies you?”

“She has almost no lymphocytes,” Peggy said. “In non-pregnant patients, low lymphocytes and high D-dimer is a bad combination. The problem with D-dimer is that it is sky high in pregnancy anyway, so the significance in pregnancy is obscure in my mind.”

“Crap.” Brian sat for a moment. “What if she dies?”

“Many of our spirits will be broken, including this team, her family, and especially Josh. I’m not sure some aren’t broken already that we don’t know about.”

“I heard you saved a baby.”

“Yes. Ricky and Ann did. He’s one that I am worried might be particularly fragile.”

“I’m surprised. He seems more resilient. I haven’t seen a soft side.”

“This is where you could use more interaction with the team. Let them talk. Let them verbalize about things besides patients, medicines and blood tests.”

“I don’t want to hear that,” Brian said. “I don’t need to hear their stories. Just like NA meetings, and some of the literature that the NA leader passes out. It doesn’t help me to hear or read about someone else’s problems. I just don’t need the darkness now.”

“Don’t you need the light side also? Ricky is often hilarious.”

“I don’t want the rest of the story.”

“How do I help you open your eyes. What are some of the NA survivors telling you about life?”

“Crap. Then more crap. All they can think about is using again. There is one lady in my group who says she has been clean for a decade, and she still thinks about it every damned day.”

“My brother-in-law quit smoking twenty years ago and says he doesn’t go a day without thinking about a cigarette. I don’t have any personal experience like that, but I think I hear what you are saying.”

“They never manage to tell me how they avoid falling off the wagon,” Brian said. “It sounds like it never ends.”

“What has Pain Management said about it?”

“That it’s something that will be with me for the rest of my life.”

“Like cancer of the pancreas and lymphoma.”

“Why do you always come back to that?”

“Because we are talking about the same kind of disease. Like diabetes. Once you have it, you have it. Unfortunately, this is not like appendicitis or bladder infection. You don’t get cured.”

“But lymphoma patients sometimes get a bone marrow transplant and never hear about it again.”

Peggy raised her index finger, “But they have to watch for it around every corner. I bet they think about it every single day, worry about every visit to the oncologist, dread every CT scan, and deal with the effects of the transplant.”

Brian felt defeated. He didn’t like the idea that this was a serious illness, especially a chronic illness that could be terminal. “The real kicker is the stigma. It’s not like cancer of the pancreas or lymphoma in that people looked at those patients differently. I get the sense that people think of me as causing this illness and choosing not to get well.”

“What do you think about lung cancer and smoking?”

“Smoking causes lung cancer.”

“So, are those patients responsible for their illness?”

“I guess so,” Brian said. “More and more, people recognize that they brought this on themselves.”

“My brother-in-law, Skip, is certainly in that situation with his lung disease. We don’t talk about it in the family, but everyone knows that his smoking was the problem. Don’t you think this is sort of the same?”

“I hadn’t thought of that, but it’s a valid point.”

“Both cancer of the lung and obstructive lung disease are consequences of smoking, which is a substance abuse. They don’t die of overdose, I don’t think, but they die of heart disease, stroke, lung disease, and a lot of cancers.”

Brian scratched his ear again, “Those are physical diseases that seem more tangible than substance abuse with lethal potential. I think of it differently, and I can’t help but think others think of it differently too.”

“We can’t control what others think,” Peggy said. “But you can control what you think about it. If you approach it like cancer of the lung or obstructive lung disease, since you don’t want me to go back to cancer of the pancreas and lymphoma, it might lead you to a better outcome.”

“Man, oh man.” Brian stood and turned away from Peggy, sauntered toward the door, then turned and briskly returned to the desk. “I need to thank you. You are always here late in the morning, I can come without an appointment, you don’t set rigid time limits, and you have been insightful. I need to thank you for that.”

Peggy, totally taken aback, stood and shook Brian’s hand.

“I’ll see you later.”

The window gently affirmed Brian’s progress. Brian had to look back at the door he had just closed. Was this the first time he had heard it rattle?

Chapter 37

“I’m getting worse, Josh. I can feel it.”

It was not the greeting he expected. It shook him to the core. She had now been here four days. “What makes you think so?”

“It’s really getting harder to breathe, like before the CPAP. And they keep increasing my oxygen to keep my pulse ox up. Look, right now it’s only eighty-nine percent.” She was using a makeup mirror to look at the numbers on the monitor.

He sat and held her hand. Aspirin was keeping his fever away. Luckily for him, no cough, trouble breathing, or muscle aches had appeared, but food had lost its taste. Showered, dressed, and in good spirits, he had come to spend the night with her and to help the exhausted Labor and Delivery staff. The ride over had been through an uplifting sunset and a warm breeze. This revelation spoiled the pudding.

“We need to check this probe out,” he offered, looking at its pristine appearance and perfect placement. The truth was repulsive. It wasn’t the probe. His heartthrob was becoming critically ill. She was going to need a ventilator. What if we didn’t have one? In the guise of needing the bathroom, he left the area, found a stall, sat, and cried.

In less than an hour, Peggy sat with Josh at the side of Faith’s bed. Ricky appeared in PPE. Josh knew what was coming and didn’t like it a bit.

“We were thinking we should intubate you, Faith, since you are getting worse, and we don’t want this to become an emergency.”

“I was thinking I was getting worse. It’s now hard to breathe even with my CPAP.”

“So, I’ll tell Ann we agree with her,” Ricky said and disappeared as stealthily as he had appeared.

“Will you put me to sleep?” Faith asked.

“Yes. You won’t know a thing,” Peggy said.

“Josh.” She coughed again. “Kiss me. What if I don’t see you again?”

“Don’t talk like that. I’ll see you later. Get well quick.” He kissed her. “Go back to Sandia Peak.” It sounded lame this time.

Ann appeared, Josh held her hand, and Peggy emptied one full syringe of milky white propofol and one clear syringe of vecuronium into her IV. Faith’s body relaxed, she stopped breathing, Peggy slipped the endotracheal tube in, and hooked the tube up to the ventilator. With each breath it gave her, she listened to Faith’s lungs, then applied the stabilizing device between her teeth.

Faith’s pulse ox came up, her skin pinked, and her blood pressure decided on its position. “One hundred percent,” Josh exclaimed. “We haven’t seen that in a while.”

Peggy was encouraged, too. “This step was clearly necessary.” A Doppler materialized and Cori’s heart swished along.

Peggy and Ann exited the ICU and removed their garb. “She looks a lot better like this,” she told Ann.

“Yes, but I’m not happy,” Ann said. “This just seems to be gradually declining.”

“Well, but at least it took four days to get to this point. That’s better than any other patient we’ve had who needed a ventilator.”

“Is that a good sign? Or are you rationalizing?”

“I don’t know. I’m not happy, either. Are we getting any more lab tests?” Peggy asked her.

“No,” Ann said. “A, I don’t want to know. B, it won’t make any difference. And C, tomorrow is soon enough.”

“Yes. You’re right. I’m just anxious.”

“We all are,” she agreed. “Haley’s a mess, Josh is a basket case, and Emily keeps calling me. I even heard from Michelle Scroggins today.”

“The department chairman? Is that right?”

“Haley and I talked for half an hour this afternoon,” Ann said.

“Were they friends before the residency?”

“No,” Ann answered. “Haley came from Arizona, and Faith is from Texas.”

“I knew Faith was from Texas. She only has to open her mouth to know that.”

They both looked back through the window in the door, but neither could quite read the numbers on the monitor.

“This has been a hell of a run,” Ann said. “We’ve had deaths, I helped Ricky do a true cesarean section to save a baby while it’s mother died, and now Faith is threatening.”

“I haven’t been sleeping well,” Peggy admitted. “I shouldn’t burden you with this, but this has been a ‘run,’ as you said. I have had dreams about patients, which I only had one other time in my career.”

“I’m sorry,” Ann said, “although it is reassuring that you are telling me this. We are all having our issues. I am most worried about Ricky.”

“Me too. But in recent days, I think he is better. I think he and Haley play off each other, and that seems to be a good thing.”

She and Ann strolled down the hall making small talk.

After Josh had regained some composure, he held Faith’s hand. “OK, you turkey, you need to stop this right now, snap out of it, and get out of here.”

He used her hairbrush to refresh her ponytail and tighten the clip. Her silky hair always lifted his spirits. He put her silver stud earrings back in. He picked up the Doppler and listened to Cori’s heart. “Hello Cori. You need to hang in there while your mother gets well. Don’t leave me.”

He adjusted her pillow and folded one arm on her abdomen. “Cori sounds good, doesn’t she?” he said to Faith. “I’m glad she’s OK. Now you have to get well!”

The sedatives were working. She didn’t move. Her face looked peaceful, an expression he hadn’t seen for days. It was obvious she was declining slowly, but he tried to blink harrowing thoughts away, trying to enjoy the moment. Her eyes were closed with ointment in them to protect the corneas. The tube was in her mouth, with wires and tubes all over the place. He had seen ICU patients before, and several of them had required a ventilator, and two of them that he had taken care of had died. While he was intimately familiar with critical care equipment, it was unwelcomed and repugnant now. How would this end?

A nurse came to check on her, made a few notes about the pulse ox, heart rate, and temperature. Her fever was back. In a moment, the nurse pulled a foil wrapped suppository out of her pocket. Josh tipped Faith up, enabling the nurse to place the suppository, then gently let her back down, rearranging her into a comfortable position.

“You have to knock it off with this fever thing. You’ve been in the hospital long enough that you should be past that.”

He sat and looked at her. Suddenly, he thought about Natalie.

“Hi, Josh. I hope this is good news,” she said.

“It’s not.” Josh felt the tightness in his chest he had felt when Peggy put her to sleep. “We had to put her on a ventilator. She just couldn’t do it on her own.”

“Oh, Josh,” Natalie blubbered. “This is getting worse!”

“Sorry. I tried to tell her, but she didn’t listen.”

He could hear shuffling in the background. “Josh, this is Jim.”

“Hi, Jim. She’s getting worse.”

Marianna came on also. “What happened?”

“They intubated her, mom,” Natalie said.

“What does that mean?” she asked.

“They put her on a ventilator, Mom,” Natalie said.

“Oh my gosh,” she said several times. “Josh, is she going to get well?”

“I hope so. Since I’m coronavirus positive, I’m allowed to sit with her, for which I am incredibly thankful. If I wasn’t positive, I wouldn’t even get to see her.”

“Can you send a picture?” Natalie asked.

After adjusting the sheet and blanket, and with the pillowcase over the tube, he took a picture. It looked like she was sleeping.

“Where is the tube?” Natalie asked.

“Under the corner of the pillowcase.”

“Can I see?”

This time he moved the pillowcase, revealing the tube, the right-angle joint, the tiny hose that measured pressure, and the tube in her mouth to get the air out of her stomach and through which they planned to feed her.

Natalie exploded. “Look at her! What are they doing to her?”

“I didn’t want to show you these, Nat,” Josh replied. “Delete it from your phone, and don’t show it to your mom!”

Too late. “EEK,” Josh heard in the background. “That’s my baby!”

“She’s OK,” he said, even though he didn’t believe it. “She’s comfortable, her oxygen is much better than at any time since she came in the hospital, and she has time to get well.” Josh used the Doppler so they could hear Cori’s heart.

There was a long period of silence.

“Natalie said you have the virus too,” Jim’s voice was even and calm. “Are you OK?”

“I’ve had a little fever, but a few aspirins have taken care of it. I’ve had no cough, muscle aches, or breathing trouble. If I hadn’t had the test, I wouldn’t know anything was amiss. I wouldn’t go to a doctor, and I probably wouldn’t stay home from work.”

“We’ve heard that on the television. They are talking about patients not even knowing they are sick.”

Natalie took up when Jim paused. “She looks like her color is better and she has a peaceful look on her face. I see she has earrings in, and her ponytail is pulled back.”

“Yes, Nat. I try to keep her presentable. I know she would want that.” Josh’s voice was tremulous.

Natalie responded to Josh’s pain. “Are you OK?”

“What? My coronavirus? Yes, fine. My mind? No, blown.” He considered confiding his fears, but she was fourteen.

“Thanks for calling us, Josh,” Jim said. “Keep calling us.”

“I will.”

“Put those pictures away, Nat!” Jim ordered her sternly. The call disconnected.

Chapter 38

“Can you believe they want me to go in the hospital?” Brian blurted before the fellows’ closet door closed. He was well on his way to a rolling chair before the window rattled. “My Pain Management appointment was this morning, and the psychiatrist recommended that I spend two weeks in the hospital to get some intensive therapy and adjustment of medications. This is getting nasty, don’t you think? Two weeks!”

Peggy thought this was the most wonderful turn of events she had heard on Brian’s behalf. A real detoxification could happen, since Peggy doubted Brian had accurately reported his drug use. With addicts, the only way to know the truth is with blood test confirmation. As a captive, psychotherapy and behavioral therapy could happen more than once a day, with forced compliance on medicines, therapy sessions, and blocked street drug use. He could remain captive until some major improvement in his depression was evident, until side effects of aggressive medicines, many of which were combated with more medicines, had been controlled, and until the roller coaster of medicines and depression evened out. She couldn’t say any of that to Brian. Care was needed since Peggy did not know exactly what Brian’s caregivers were thinking.

“What did they tell you? Or, more exactly, what did you tell them that you don’t know you told them?”

“I told them I was having trouble concentrating, that I couldn’t get pain medicines off my mind, and that I didn’t want to use their sleeping pills very much.”

“Have you succumbed to some Percocet?”

“No,” Brian said, his face hinting otherwise.

“Congratulations. Have you thought about killing yourself?”

“Who could answer no to that question?”

Peggy thought that was an odd answer, but perhaps sharply truthful. “Have you thought about how you would kill yourself?”

“No.”

“Do they think you want to kill yourself or that you know how you would do it?”

“I don’t think so.”

“Do you want to kill anybody else?”

“Josh Menkowicz,” Brian said without the briefest pause. The answer hit Peggy like a handgun slug, nearly knocking her off her chair.

“Truthfully? Or a metaphor?”

“Less than truthfully, more than a metaphor.”

Perhaps the caregivers were concerned about this also. Hospitalization is indicated when the patient is a danger to himself or others. Maybe his caregivers were more worried about him hurting someone else than about hurting himself. In looking back, Peggy could remember bits of conversations in which the wellbeing or feelings of someone else did not appear to matter to Brian. Were that true, it would make Brian sociopathic, something Peggy had not considered, and something that would make the prognosis abysmal. You can’t fix sociopathy.

“Did they talk about special medicines or treatments they want to try?”

“Yes. They want to switch my antidepressants around.”

“Did they tell you they can’t do that with you at home?”

“No.” Brian shifted the conversation. “They talked to Emily. I think they told her I should take a few weeks off work until I get a little better, and not treat patients in the meantime. I don’t like it that all these people are talking when I don’t know what they are saying.”

“How can they talk to Emily without your consent?”

“JD made me sign some forms so that he and Emily can be sure I go to my meetings, make my appointments, take my medicines, submit my medication logs, and do my physical therapy.”

“Physical therapy?”

“For my knee.”

“Is it working?”

“I don’t think so. It makes my knee sore.”

“Did you take anything for that?”

“Some aspirin. It works pretty well.”

“That’s a good sign.”

“Do you think I should go in the hospital?”

“Yes.” Peggy wanted to reinforce the idea. “JD has spent his whole life researching and writing about opiate addiction in the workplace, and he certainly knows as much about it as anyone. Apparently his unit has national notoriety. I would follow his advice.”

“Well, this is the advice of one of the psychiatry hospitalists.”

“Undoubtedly with input from JD, right?”

“I don’t know. Maybe.”

“So, ask JD. Tell him you don’t have a clear idea of the value of a hospitalization and see what he says.”

“How do I do that? You can’t just call on the phone.”

“Email?”

“OK. I hadn’t thought about that. See, I don’t have the concentration, I don’t have the acuity. My distractions are strong. I am weak right now.”

“It is an amazing accomplishment that you are recognizing it. This is going to take time, not like an antibiotic for a bladder infection where you’re back to normal in three days. It’s going to be more like cancer of the pancreas or lymphoma.”

“You’re back to that, now?”

“I hope we never left it. I hope we are looking at this as a complex disease that is going need several approaches and numerous interventions. It’s going to have aggravating aspects and disappointing setbacks which you will manage for a lifetime. Like cancer and lymphoma.”

“God, did we just make a full circle?”

“Oh, heavens no. A major intervention is coming your way, like a marrow transplant for lymphoma or a Whipple operation for cancer of the pancreas.”

Brian’s face showed apprehension. “That sounds scary.”

Peggy fought back, “It’s called hope. You have hope for a future. It’s being offered to you for free. I don’t see that there is a downside.”

“I have to think about it.”

“Don’t think, just do it. I can pick you up and take you there.”

“Do you think it’s that good?”

“Oh, yes! Do you want me to take you now?”

“No, I need to go home and get some things. I can come back. It will only take me an hour or two. I’ll call if I need a ride.”

“Good, good,” Peggy stood, mostly out of excitement and encouragement.

Brian’s departure was abrupt, but typical.

Peggy was on call, and became busy with patients for several hours. She didn’t hear from Brian, but wasn’t concerned. Later in the evening, she called Brian’s cell phone which went straight to voicemail. Admission to a psychiatric hospital might mean giving up your cell phone. She took up reading a Danelle Steel novel on the bed in her call room, interrupted by only one phone call from Ann. When the book fell to the floor, she turned the nightstand light off.

“Peggy, I’m sorry to wake you.”

“Emily?” Peggy, jolted from deep sleep, had to orient herself. She was in the call room. At work.

“Peggy, this is Emily,” her voice cracked.

Peggy propped herself on one elbow and turned on the bedside table lamp. She didn’t usually do that for a nighttime phone call, but it was Emily.

“Peggy, they found Brian Yankton dead in his apartment late last night.”

“What? Brian Yankton is dead?”

“Yes. It looks like a suicide. The police are investigating.” Emily was whispering.

“OK. Are you all right?”

“No. This is awful.”

Peggy waited for more from her, but she didn’t say anything. “How did we find this out?”

Emily was silent for a moment. “He didn’t show up for his admission,” a yodel in her voice. “I don’t know the details, but Albuquerque Police Department did a wellness check and found him.”

“Oh, man, this is awful. Who knows about this so far?”

“You and JD Thompson. He’s the one who called me.”

“Do you need help informing everybody? It’s Ann, Haley, and Ricky on call here tonight.”

“Morning rounds is soon enough for them,” Emily thought out loud. “I just wanted to talk to somebody, and I knew you were in the hospital.”

“Somebody should call Josh.”

“Gosh, Peggy, I didn’t think of him. I thought of Faith, but we can’t tell her now.”

“I’ll handle Josh.”

“I wish I had done more about this.”

“You took care of him the best you could, Emily. There were a lot of people involved with him.”

She sniffled. “I just — ”

“Don’t go there,” Peggy warned. “It won’t help. Is anyone contacting his family?”

“I assume so. I don’t know very much about him.”

“I don’t either.”

“I’m embarrassed that I don’t know more about him, but he was such a loner, and so distant all the time.”

“You told me recalcitrant.”

“The understatement,” she said.

“Yes.”

“See you in the morning,” she whispered. “Thanks for talking.” The call ended.

Peggy looked at the display on her phone, selecting Josh from her contacts. Josh answered too promptly to have been asleep. “Peggy.” Confusion was audible. “What’s up?”

“Where are you, Josh?”

“Sitting here with Faith.”

“I have bad news. Are you ready?”

“Um. OK.”

“Brian was found dead in his apartment. He never appeared for an admission to the hospital, so APD went to check him out, and they found him. Their impression is suicide.”

There was a long silence. “OK, Peggy,” Josh whispered. “That’s bad news. Thank you for calling.”

“Is there anything you need or anyone I should call?”

“No. I can manage.” There was a long pause. “What happened?”

“I don’t know more than I told you. He did come talk to me yesterday afternoon after he had been to Pain Management where they recommended the admission. I thought he was as upbeat as I have seen him, mostly, and he didn’t say anything about suicide. In fact, he denied feeling that way. When he left me, he was planning to go home to get a few things and come back for his admission.”

“I have to admit,” Josh’s voice cracked, “that we haven’t been in touch with him for a long time. Faith and I have wondered if there was more than anger and — we aren’t exactly at the top of his love list. We didn’t think there was anything we could do. In fact, he has treated Faith so poorly that we avoided having any more contact than work forced upon us.”

“Did you know about his opiates and the intervention by Dean Thompson?”

“No, just some hints from Haley,” Josh said. “I just thought he was a jackass, which is what the rest of us think. Ann is the most vocal. Faith has never said anything about opiates.”

“I didn’t want you to hear it in the hallways. We can talk about it later. Please help me know how to break it to Faith.”

“Well, obviously, not now,” Josh said. “When she wakes up.” He whispered again. “If she wakes up.”

“She will,” Peggy said. The short words caught in her throat. “I’ll be by later today, Josh.”

A few hours later, Peggy approached, all dressed up. “Boy, you’re early,” Josh said.

“I couldn’t sleep, and I wanted to talk to you before you went home.”

“How did you know about that?” Josh asked.

“Haley. It makes sense that you would be here in the night to help with Faith. Haley says you have even helped with other COVID patients we have in this little unit.”

“Since I already have it, those patients aren’t a hazard to me that I know of,” he said. “The staff is both short on numbers and enthusiasm on night shift.”

“Of course. They probably are on day shift as well.”

Josh sat back down in the chair against Faith’s bed. Peggy scavenged a stool and sat at the foot of her bed. “Tell me more about what you know about Brian,” Josh said.

“Well, he’s been coming to talk to me for quite a long time. At first, he wasn’t pleased I was here since I am not certified in maternal-fetal medicine. At about the same time, Emily had begun applying pressure because he had failed his basic obstetrics and gynecology written boards for the second time, and she wanted him to take up some research or get involved in the medical school. What he told me is that he lacked energy. Then the subject of opiates came up because I noticed pinpoint pupils. Later, Dean Thompson began applying pressure also. Yesterday, they recommended a hospitalization for which he didn’t show.”

“Gosh, Peggy, I didn’t know all that was happening.”

“I’m sad and disappointed, but I’m not surprised. It all fits. Failing boards, poor work performance, a disintegrated marriage.”

Josh squirmed. “I don’t know how Faith will take this.”

“Hard. He was her husband of what? Four years at least?”

“Yes. Something like that. Does everyone else know?”

“No, but we’ll talk about it at rounds this morning.”

“Gosh, Peggy. This is unbelievable. I’m sorry.”

“Is there anything you want me to do?” Peggy asked.

Josh shook his head, “I don’t think there is anything to do. I don’t know his family. She never even talked about them.”

“You know you can call or text any time you need something,” Peggy said, standing to go.

“Thanks, Peggy.”

Peggy scurried through the hall to the charting station, only a few yards away. There was the usual gathering for rounds. “What happened?” Ann asked.

“I heard suicide is APD’s impression,” Peggy said.

“APD?” Haley questioned.

“Albuquerque Police Department,” Ann said.

There was silence for a period.

“I didn’t see this coming,” Ricky said. “Did anyone know anything?”

“I had no idea,” Ann said. “I just thought he was a jerk.”

Haley said. “This is getting horrible. We had three patient deaths, now an attending death, and — how can this get worse?”

There was more silence.

“Now I kind of feel bad,” Ann said.

“I wonder if he was coronavirus positive,” Haley said. “I read about neurological effects of coronavirus with seizures, strokes, and suicides.”

“Is that so? I had not read that,” Peggy said.

“Interesting,” Ricky said. “I didn’t know him either. It seemed like he avoided me.”

Heads were shaking.

“Does he have any family?” Ann asked.

Haley thumbed her phone for the directory in the hospital computer system. “He has parents in Brownfield, Texas, and Faith. That’s all.” She paused, then, “I can’t believe we have had four deaths. Three COVID and Brian. Faith is critically ill. Frankly, I find this terrifying. Life is fragile and short. We have to love and enjoy each other. We should go have Taco Tuesday tonight, anybody not on call. Shut up Ricky.”

She got approving grunts, groans, and elbow bumps.

“We can’t,” Ricky said. “Either we eat on the patio or we carry out. There’s no indoor dining right now.”

“And it’s not Tuesday,” Ann said.

A barrage of simultaneous comments, “They still have tacos.” “And great Margaritas.” “I don’t think it’s too cold to sit outside.”

“It is a wonderful idea that you guys talk tonight,” Peggy said. “It doesn’t even matter if you talk about this. Just talk. Where is Taco Tuesday, anyway?”

“At Padilla’s,” Ricky said. “It’s right around the corner from your house. You and Alicia are invited. And we need another Margarita.”

“Oh. My. Gosh. Ricky.” Haley was rolling her eyes. “I can’t believe you said that.”

“I loved it, Ricky,” Peggy relishing the abuse of her name. “You don’t want me for this, do you? You guys need to have your freedom to say what you want. I don’t want to inhibit anybody from speaking their mind.”

Ann said, “You never do that. I don’t think anyone would be afraid to speak their mind in front of you. We have learned that you don’t tell anybody things we tell you, and we feel completely free to badmouth people, even you to your face. So, I think if you like good tacos, you should come. The fish tacos are the best.”

Haley started rounds. “One of the patients came off the ventilator last night and is on nasal oxygen. The other is holding her own. They both are positive for coronavirus. We’ve got another coronavirus-positive labor patient in the first room beyond the fire doors who will deliver this morning. Pediatrics is isolating babies of coronavirus positive moms. Imagine not being able to hold your baby or take your baby home.”

“Faith did well overnight,” Ann said. “Her oxygen and PEEP have not changed, and her D-dimer is down to twice normal, which we are interpreting as normal for pregnancy. She has almost normal lymphocytes. It looks like she could get rid of the ventilator soon.”

“That’s good news,” Haley said. “Does Josh know about Brian?”

“Yes,” Peggy said. “I talked to him right after Emily called me, then I talked to him in person this morning. I wanted to see him before he went home.”

With a new weariness and almost no conversation, the group wandered off to their tasks.

The spring weather could not brighten the spirits of the group as they convened at Padilla’s. Nobody noticed the bright yellow cactus blooms near the front door, no one thought about the fresh, warm air, and the clear, dark blue, star-studded sky was ignored.

“My mind is blown,” Haley said.

“That happened way before this,” Ricky said.

“Shut up, Ricky.”

“Mine is too, if that’s any consolation,” Ann said. “It’s all right if I’m here, right? You didn’t exactly invite me, and I’m not a resident.”

“But you were a resident here,” Haley said. “Where’s your hubby?”

“On call.”

Gradually, chips, cheese, salsa, Peggy, and margaritas arrived at the table. There were jackets and hats, more against the wind than the temperature, but no one seemed to care.

“I can’t believe you guys are in hoodies and coats,” Ann said. “In Detroit, this would not be cold. Anybody want mittens?”

“It’s the wind,” Haley said.

“Yeah,” Ann answered. “Is it this cold in Arizona?”

“No!” Haley buffed back.

“Only her heart is cold,” Ricky said. “It’s not cold for Topeka, either. It is amazing how quickly you guys drag out the parkas. I thought parkas were for when it was cold.”

“Shut up Ricky.”

“I’m glad you came, Peggy,” Ann said. “We need some parenting.”

“Is that what you think I do?” he said.

“In some ways, yes,” Ann said, “but we need it. We need to learn medical things, but we also need to learn life things. Like, I struggle with the interface between work and home.”

Julio came to the table. “Can this please be Taco Tuesday?” Haley asked. “We don’t need Tuesday’s discount, but we need comfort food — tacos.”

“Of course,” he replied. “Is two dozen enough to start?”

“I think so,” Ann said. “Make some of them fish.”

“And some al pastor,” Ricky added.

Julio took drink orders and disappeared.

“Do you have kids, Ann?” Peggy asked.

“No. Not yet,” she said. “Some day after training is done.”

“Because you think you will have more time?” she asked.

“Yes, when I have more control over my time.”

“Well, then, someone lied to you. You will have the home versus work battle all your life. You will always be short of time, training is never done, and two physicians in one house might amplify the potholes.”

“I didn’t want to hear that.”

“And things like COVID will always be around. Some of them will be in your private life instead of your professional life, and some of them will threaten your patients but not you. Some will threaten you and not your patients.”

Ricky said, “Don’t you think this pandemic is a little spectacular? Don’t you think this is a real monkey wrench?”

“Oh, yes,” Peggy said. “But you could get another monkey wrench that is just as life-changing. A special needs child, a serious health issue, or a legal disaster.”

“That sounds pessimistic,” Ricky said. “Is life actually like that?”

“Yes. We all have, have had, or will have upsets along the way. This one is different in that it is affecting all of us at the same time. Most of the calamities we have only affect us individually, or our family. We should be thankful for the bumps in the road we don’t have, and feel good when we survive the ones we do have.”

“Did you just reference Brian?” Ann asked.

“Yes.”

“I didn’t get the message you wanted to send,” said Ricky.

“Well,” Peggy said, “he is a good example of someone who had a life-threatening illness compounded by the pandemic. Maybe he could have survived the pandemic without the opiate problem, or maybe he could have survived the opiate problem without the pandemic. It could be that the combination, either of which could have been lethal in any case, broke the camel’s back.”

Julio brought tacos and drinks, a big bowl of guacamole, and several baskets of chips. After a quick trip away, he returned with a huge pitcher of Margaritas and several mugs of beer.

“Golly,” Ricky said, “think of Faith. She got a divorce from an opiate dependent husband I have been thinking was abusive, she faces what we faced with patients who died, gets critically ill with coronavirus, and now the ex-husband died. And she’s going to have a baby. How much thicker could that get?”

“Don’t you think Faith will come through this better than Brian?” Peggy asked.

Ricky shook his head, “How so?”

“Brian is someone life happened to. Faith is someone who makes life happen.”

“So, then, how do we get out of this pandemic mess?” Haley asked.

“Just keep chugging along, solving one problem after another, until the project is completed. I know all of you can do it, because you all went to college and medical school, and one of you completed a residency. You all come to work one day after the next until you complete your training.”

“You don’t think this can last forever?” Ricky asked.

“No calamity lasts forever. I’m sure Josh thinks coronavirus is lasting forever, I’m sure soldiers think tours of duty last forever, and there are some for whom diseases or pregnancies last forever. But the truth is they don’t.”

“That sounds hollow to me today,” Ann said. “I went to see Faith this afternoon and wondered how this would end.”

“I understand that,” Peggy said. “But it won’t last forever.”

“What if it doesn’t end well?” Ann asked.

Peggy shook her head and looked at Ann’s neatly coiffed, curly black hair, “Then we figure out how to deal with it and go on.”

“That sounds crude,” Haley said.

“We can console each other, support each other, and help each other over the hurdles, but in the end, we get a grip, tackle our own feelings, and treat others the way we would want to be treated. Then we move on.”

“So, what are you feeling about Faith and Brian?” Ricky asked. “Deep down and dirty.”

“I have a lump in my throat about Brian. He talked to me that afternoon, and I didn’t see him as a danger to himself. I am comforted by the fact that others, people who know a lot more about opiates and depression than I do, might not have thought of him that way either. I am terrified of the disease that is confronting Faith, and whether we who are involved with her will be able to rescue her from a game where we don’t know the rules.”

“It’s good to hear you say that,” Ann said, “because I feel a little helpless or useless. I’m glad I’m not alone.”

“Me too,” Haley said.

“You guys are not alone. If you need to talk to me alone, come find me in my ‘fellows’ closet.’” Peggy stood. “Thank you guys for inviting me. I told Alicia I wouldn’t be long, so I think I’ll head out.”

“See you tomorrow,” someone said.

“I don’t know how that woman does it,” Ricky said. “She always seems cool and controlled and full of wisdom.”

“She told me,” Ann said, “that she blows off to her wife or to her veterinarian friend. Sometimes she rides her bicycle or does yoga.”

“You’re saying that we just don’t see it,” Ricky said.

“Yes, I believe that’s it. She has the same feelings and vents just like we do, but she doesn’t do it in front of us.”

“I thought this was very helpful,” Ricky said. “We should do it regularly.”

“We were for a while,” Haley said. “But we’ve been busy, so we slacked off.”

“I’m tired,” Ann said. “I have to go home.”

“We do too.”

“Did somebody pay Julio?” Ricky asked.

“I didn’t,” Haley said.

“Neither did I,” Ann said.

“Julio,” Ricky shouted. “We need our check.”

“You’re all paid up,” Julio answered. “And I got a good tip.”

“Who paid?” Ann asked.

“The older lady.”

Chapter 39

“Code blue, Labor and Delivery, Code blue, Labor and Delivery.”

Peggy and Ann approached Faith’s bed in ICU where personnel, including Haley and Ricky, were rapidly amassing. Josh was scrambling to get out of the way. A defibrillator and a crash cart had been brought up to her bed.

Josh, flushed and tearing, said, “I have to get out of here!” He darted for the door, Ricky right behind him.

Ricky diverted Josh to a corner of the unit and talked with Josh, soothing him as best he could, struggling to remain calm himself. Mostly, he just listened. “What happened, Josh?”

“I don’t know. We were trying to talk to her. She was responding a little bit, but we didn’t think she was ready to extubate. Since we ran out of fentanyl and propofol to keep her asleep, we have been using old slow drugs morphine and methohexital, so she doesn’t wake up as fast when we stop the drugs. We even thought it might be another hour or two. Suddenly she started moving her arms, reached up, and pulled her tube out. She hasn’t done that before, so I didn’t expect it. She also bent her legs up. I called for help when the tube came out. I didn’t know what to do next. Somebody brought me an Ambu Bag to breathe for her, but I was terrible at it. Her heart rate went down, and I melted. That’s when Haley arrived, and I was so glad to see Ann and Peggy.”

Ricky put his gloved hand on the sleeve of Josh’s gown, easing him into a chair. From where they sat, part of the conversation was audible. Neither of them could hold off tears.

Josh went on, “Then all kinds of people started coming, and I heard the page for the Code Blue. I can’t believe this is happening. After all we’ve done. I thought she was pulling through. I thought we had it made. I told her family that she would likely come off the ventilator later today, and that she was getting well. This is bad. This is so bad.”

“They’re working on her, Josh,” Ricky said. “They can figure out what’s up.”

Peggy, Ann, and Haley talked among themselves, discussing the possible reasons Faith’s heart stopped, ordering medications and lab tests, and introducing themselves to others who had come to help. From where Josh and Ricky sat, it appeared orderly.

Ricky listened to Josh. “I didn’t know what to do when she yanked her tube out. I didn’t know she would do that. There was no one else in the room with me. I felt so helpless.”

“I would have, too.”

“So why didn’t she breathe after the tube came out?” he asked.

Ricky stayed silent.

“Should I call her sister?” he asked. “What am I going to say to Natalie if Faith dies? What am I going to say to Jim?”

“Why don’t we wait a few more minutes while they figure out what happened and get things back to normal? We don’t have much information. I can’t imagine what we would say to them at this point. To them, I’m a stranger. You’re in no shape to talk to them. It would send them into a tizzy, and they couldn’t do anything about it.”

Josh mumbled, “I wonder if Faith knows what’s happening.”

“I don’t think so. You said she wasn’t awake before she took her tube out. And you said the old medicines work a lot slower than the new ones. I bet she’s still asleep.”

“Please don’t die, Faith. Please don’t take Cori with you. Please don’t leave me.”

For a short burst, a heart rhythm appeared on the screen of the monitor, above the heads of the people working on her. Chest compressions stopped, and there was movement of people and equipment. Suction made its disgusting noise, someone talked about epinephrine, and then chest compressions began again.

Haley and Peggy were talking, with Ann listening. “It seemed like she was ready to come off the ventilator, and yesterday, she passed the test.” Haley was reciting. “She took her tube out, which we might have done anyway, just a little later in the day. So why didn’t she breathe?”

“There has to be something else,” Peggy said.

They became busy again with medicines, chest compressions, and ventilator settings.

Time dragged on, making Josh wonder if this was about to end and end badly. “Has this been going on a long time?” he asked Ricky.

“No, less than ten minutes.”

“That’s what I meant. Don’t we quit at thirty minutes?”

“If there is no response. But she had a rhythm there for a while and they stopped compressing. It looks like they sent off lab tests, ordered a chest x-ray, and tried to take a blood pressure.”

Josh spewed a flurry of unrelated stories on Ricky. “I talked to her family yesterday. They were all upbeat and excited that she was improving. Her sister Natalie is only fourteen, yet she understands so much in life. She has been good for me. Jim has a deep, comforting voice. Her mom, Marianne, hardly talks.”

“It sounds like you know them well.”

“I’ve been talking to them twice a day since Faith went on the ventilator. One of the anesthesiologists told me that some patients are aware even though they don’t respond and even though they don’t remember after they wake up. So, I have been talking to her, too.”

“I didn’t know some of them were aware,” Ricky said. “That’s amazing. I will have to remember that.”

“We have loved eating together in the evening. We do that in the cafeteria downstairs when one of us is on call. Sometimes we go to Padilla’s when we are both off. It’s amazing how many blue enchiladas that girl can eat.”

“That’s a good place.”

“Yes. And I like to cook for her. We are only off together the night after she is on call, so I try to have dinner ready when she gets home. It’s the only time we can talk.”

“Residency is hard,” Ricky said. “But then you get out of it what you put into it, so taking it easy is not in your best interest in the long run.”

“We both stay when there is something interesting going on.” Josh paused, leaned forward placing his elbows on his knees and his head in his hands. “My sister Marla, who’s an attorney in Santa Fe, helped her do the paperwork for her divorce from Brian. Faith was happy and relieved by that. But in the process, it was so hard for me to get her romantic attention. It’s like she doesn’t get the main idea sometimes. I didn’t get her attention until she had to move out of the apartment she had with Brian.”

“That’s when she moved in with you?”

“Yes. Her family came to help her move and I got to meet all of them in person. That was fun. I especially like her dad and her sister. It’s fun to torment her sister, she reacts so dramatically.”

“It’s good you have that kind of relationship with her family.”

“Then the night she found the positive pregnancy test, she was shocked. At first I thought she was down about it. But it turns out that Brian would have wanted her to have an abortion, which she didn’t want. Now we are both so excited, and we are so happy it’s a girl. We’ll call her Cori.” He paused. “This sounds like I am saying goodbye to her, doesn’t it?”

“No. You are just telling me about the happy parts of your relationship with her. You guys have such a warm relationship,” Ricky said, his voice cracking. “I hope you have it for a long time.”

“I do too,” he answered. “But it doesn’t look good, does it?” It was an excruciating question.

“Do you think Brian abused Faith?” Ricky asked.

“Um,” Josh said, “not physically, in that she told me he never hit her. But psychologically I think he did. She really was very subservient to him, always wanted to please him, and rarely succeeded. You can tell by all the times she asked whether Brian’s anger and his affair were because of her coming to Albuquerque, or because of her kicking him out. I think she is coming around, though, because I never do those things to her.”

“That’s good. You need to keep going on that.”

“I will. I want her to have control of her life, some control of our lives, and to be the mother she wants to be, not the one I want, her mother wants, or anybody else wants.”

“They’re talking about radiology,” Ricky said. “I think they’re talking about taking her to radiology! Can you believe that?”

“How do you do that when she’s coding? Keep pumping on her chest in an elevator?”

“Let me step over and see.” Ricky walked over, had a short exchange with Haley and came back. “Peggy thinks she has a big clot in her lung and that they may be able to get it out with a catheter in radiology.”

“Is she insane? Or do we not know what we are talking about?”

“I don’t know what I’m talking about, that’s for sure,” Ricky said. “I guess they move people who are coding in an ambulance, don’t they? I suppose you need to get the patient somewhere where survival is more likely.”

“I guess they do.”

Then Peggy’s voice came clearly, apparently having been challenged by someone in the room whom Ricky and Josh had not heard, “Yes, we don’t have any choices. If we don’t try to address the clot, we won’t have a patient. While moving her could kill her, staying here won’t end well.”

Ricky and Josh watched as the monitor was taken down off the shelf and placed on the foot of the bed, an oxygen tank was connected to an Ambu Bag, and IV lines were placed on a pole attached to the bed. The bed began a slow movement toward the door, which Ann opened and held out of the way. They watched the as the bed moved out the door, as the mass of people and equipment progressed down the hall, and as the elevator devoured the bed, patient, and caregivers. As the elevator door closed, chest compressions had started again.

Ricky said, “Let’s wander down in that direction to keep up on the news.”

“What?” Josh said.

“I know where they are going, and we can get there by the back stairs. That way we can keep up on the news.”

“This seems like a last-ditch effort,” Josh said. “What chance of success do you suppose it has?”

Ricky shrugged. “I don’t know. But doing nothing won’t help. We discussed that at Padilla’s the other night. If you don’t take action, you’re accepting failure.” By now, Ricky was marching at a brisk pace. Josh didn’t see the stairway before Josh ducked into it, making him spin to retrace a few steps to follow.

Ricky seemed to fly down the steps, two at a time. Josh would never have been able to select the correct door to exit the stairway since there were identical doors on every landing, and some had two. Ricky selected one of the least obvious and exited. After several hallway turns, Josh now completely lost, Ricky ushered him into a tiny waiting room that had only about six chairs.

“I wish I had dropped pebbles or crumbs,” Josh said. “There is no way I could be back to Labor and Delivery without help.”

“Sit here while I scope this out and make sure we’re in the right place.” Before Josh could answer, Ricky vanished. All he could do was stare at the floor and relive her removing her tube.

“They’re in an arteriography room down the hall. They had to stop working on the radiology procedure because they had to start doing chest compressions again. I guess the ultrasound showed a big clot in the right main pulmonary artery. The radiologist thinks he can get it out if he can thread a catheter from her groin into her lung.”

“I don’t know what I’ll do if she dies,” Josh said. “It will mean that I lose Cori too.”

“Yes. But Josh, it’s not over yet. The radiologist thinks he can blow it out.”

“Blow it out?” Josh said, horrified. “How does that work?”

“What I heard was they inject high pressure saline behind the clot, pushing it back out into a gadget that grinds it up and sucks it out.”

“We do that with fibroids tumors of the uterus using a laparoscope,” Josh said. “I have never figured out how such a tiny grinder can grind up a big fibroid in just seconds.”

“I’ve never seen that procedure,” Ricky said.

“Yeah,” Josh said, “they did that in Oklahoma City.”

“OK. Well anyway, that’s what they’re thinking with Faith.”

“But she has to live that long.”

“They aren’t doing chest compressions all the time,” Ricky said. “I think that’s a good sign.”

Josh began reminiscing again. Something inside him needed to be released. “I took her a yellow rose one night when we went to dinner.”

“What did she say?” even though he remembered.

“Thank you.” Josh amazed himself by chuckling. “She totally didn’t get it. Later she told me she talked to her sister afterwards, and the fourteen-year-old interpreted the yellow rose. I have never let her off the hook about that. I have since thanked Natalie for helping me get Faith’s attention.”

“It’s amazing how insightful and knowledgeable she is here at work. She seems so connected to patients, their problems, their preferences, and their personalities. Her anecdotes about patients are hilarious.”

“I know. But at home, sometimes she is completely clueless. As if she’s a different person. She totally didn’t get the rose. It’s amazing. Her dad says she has always been that way, and that her kindergarten teacher said she had trouble getting the main idea.”

“I’m going back down the hall,” Ricky said and slipped out the door. Josh agonized while Ricky was away and relaxed when he reappeared.

“Do you think I should call her parents?” Josh asked, mostly just wanting to do something.

“Let’s hold off a little longer. What made you pick New Mexico?” Josh knew this was just to get him to keep talking. Hadn’t he and Ricky discussed this before? Maybe not.

“I didn’t want to go east. I wanted warmer weather. I didn’t get picked by any program in Arizona or California, so I wound up matching here. I was disappointed at the time, but not now. I like New Mexico, I like Albuquerque, I like this residency, and I like Faith.” His heart ached again.

“Have you talked to your parents?” he asked.

“Yes, occasionally. They’re all well. I’ve talked to my sister often. We fought like cats and dogs when we were young, but in retrospect, she always helped me and protected me. What are they going to do to her?”

“In order to inject saline on the far side of the clot, they need to give her more heparin and they are worried about that. I didn’t know this, but large amounts of heparin lower the blood pressure, which she doesn’t need. Peggy was talking about giving her something to counteract that. Dopamine.”

“It’s more and more stuff,” Josh said. “When do we get to a place where there’s no coming back?”

“I don’t know.” Ricky didn’t have anything to say. “But maybe if the clot comes out we turn this around quickly.”

“That would be fine by me,” Josh said. “The sooner the better.”

Ricky stood, left the room and was gone for a long time. Josh looked at his phone wanting to call someone, but couldn’t bring himself to press an icon. He finally opened a game of Bejeweled, but played poorly. He was relieved when Ricky returned.

“The first try failed. They are trying to go for a second try, but her heart keeps stopping.” Josh saw the tears in Ricky’s eyes, and stood.

“This is not good, Ricky. It’s not good.”

“Well, they aren’t giving up,” his voice cracked. “They were changing something in the injection equipment for the second attempt. I could see the clot on the monitor screen while I was standing in the doorway. It almost completely blocks the right pulmonary artery. The floor looks like a war zone.”

“The door is open?”

“Yes. They are all hot in PPE and lead aprons. There must be a dozen people in the room.”

“How long has this been going on?”

Ricky looked at his watch. “An hour and a half.”

“So, she could have brain damage if she wakes up?”

He shook his head. “We can’t think like that, Josh. We have to give them a chance to do their work.”

Memories of Faith flew through Josh’s head. “I will never forget her. I will never forget the crumpled paper in the trash can. I will never forget suppers in the hospital cafeteria. I will never forget holding her tight at night and waking up with her on my shoulder. I will never forget when we saw Cori on ultrasound for the first time. I will never forget our trip up Sandia Peak.” He looked up. A thick evil vacuum pushed into his chest. Tears were streaming down Ricky’s face.

There was a noise down the hall, the first time they had heard anything through the heavy waiting room door. Ricky scooted out. He was back in a flash this time. “They’re cheering. The clot moved. They are waiting to see how she responds to it.”

“Do you think she will survive?”

“At least they weren’t doing chest compressions. That’s a good sign.”

“Unless they are giving up.”

“They wouldn’t be cheering about that, moron!” Ricky said with a friendly punch on Josh’s shoulder.

“Duh. I guess not,” he said. “I don’t know what to think. I don’t think I can think.”

“We might not know for a few hours or even days,” Ricky said. “Depending on how quickly she recovers from this ordeal. Now it’s my turn. I don’t know what I will do if she dies. Haley will be a worthless mess, and Ann won’t know what to do. Even Emily has called me this morning. I think I should call her now.”

“They got the clot out?” Emily could be heard on speaker. “That’s good news. What happens now?”

“We don’t know yet. They are waiting to see how she responds.”

“OK, good. I would be a mess if she died.”

Ricky ended the call. Josh dialed Natalie, but Ricky had to speak. “Is this Faith’s sister?”

“Yes,” a timid voice answered. “I’m Natalie.”

“I’m Ricky. I’m Josh’s cousin.”

“Oh! OK! I’ve heard of you.” Raw fear came in her voice. “What happened?”

“Faith had a serious and sudden turn for the worse this morning and her heart stopped. They have been doing resuscitation efforts for two hours, but now she seems to be better.”

“Get your mom and dad, Natalie,” Josh blurted.

“OK, they’re here.”

Josh took over. “This morning we turned her sedation off because it looked like we could extubate her,” sniff. “In the process, she awakened and pulled her own tube out. That’s when her heart stopped. It took a long time to get her going again. They decided that she had a clot in her lung, so they took her to radiology where they got the clot out. It looks like she’s better.”

There was a silence. “Will she be OK?” Jim’s voice didn’t sound like Jim.

“I hope so,” Josh answered.

“Is the baby OK?” Natalie wheezed.

“I don’t know. We’ll have to see. But at least we might have Faith.”

“I understand,” Jim responded. “Do you think she’ll be OK?”

“I don’t know. We’ll just have to wait and see.”

“Just keep doing your jobs and communicate with us,” Jim said.

“I’ll call later.” Josh ended the call.

Ricky led Josh through the labyrinthine halls and stairs back to the little ICU in Labor and Delivery. They slipped inside the door as Peggy, Ann and a cluster of others maneuvered Faith’s bed into its place.

Haley came up to Ricky and Josh, “We had to extubate her. The pulse ox insists she’s breathing well. She responds to voices but has not communicated with us yet.”

“Why do you think that is?” Josh asked as Peggy approached.

“It’s the morphine,” Peggy said.

“How do you know that?” Josh asked.

Peggy pointed to her chest. “Opiates make slow, deep breaths. And pinpoint pupils.”

Josh walked right up to her and opened one of her eyes. “Pinpoint is right.” Faith reached up to bat his hand away. He snapped his fingers and pointed at Peggy, “Now that’s a great sign!” He danced back to where Peggy was standing.

Nasal prongs found their way to Faith’s nose, the monitor was replaced on the shelf, and oxygen was connected from the wall. Pulse ox ninety-two percent on five liters of oxygen, pulse rate eighty-six, and a welcomed normal rhythm on the monitor.

“Oh my gosh, this is good,” Peggy breathed. “I wonder where Ann is?”

“Standing right behind you!” Josh said, snickering.

“Oh, there you are. Are you OK?”

“I don’t know. Let’s watch a few minutes, I’m thinking I might be.”

The monitor kept pinging along, the pulse ox reading steady. Peggy stepped up to Faith and spoke loudly to her. She opened her eyes but didn’t look at Peggy. “Can you wiggle your toes?” The toes wiggled just a little. “Can you open your eyes?” They opened and closed. “Can you take a deep breath?” She breathed deeply, grimacing. “Do you know who Josh is?” She turned her head toward Peggy but didn’t open her eyes. “Do you know who Natalie is?” Now she opened her eyes. She wheezed a few unintelligible words. “That’s good enough for me,“ Peggy stated boldly, looking at Josh. “Her brain is working.”

“I can’t believe this worked. I thought you were being ridiculous with the radiology thing, making us code her in an elevator, and crowding us in a little room dressed in PPE and lead aprons.” Haley, red hair drenched with sweat, was grinning. “I will never forget this.”

“This is a miracle,” Ann agreed. There were dark sweat spots on Ann’s scrubs. “This was amazing. I won’t forget this either, Haley. And Peggy, look at poor Josh. He is still recovering from the stroke he had when Faith took her tube out.”

Peggy laughed. “I’m sure that’s true. The poor guy. Coronavirus, Faith on a ventilator, Faith codes, Faith survives a usually-lethal pulmonary embolus.”

After an hour or so, it was time for afternoon rounds. Ricky allowed the murmuring and talking to go on for longer than usual, understanding the gravity of the day’s events. Even the medical students were bubbling with questions and comments. Emily and Haley were among them, exchanging raillery.

“News travels fast,” Ricky said. “No, strike that. Haley is involved.” Apparently, Haley didn’t hear.

As the conversations gradually declined, Ann began rounds. “We got delayed by Faith, so we have some catch-up work to do.” The hubbub didn’t stop. “OK, you guys,” Ann announced to get more attention. “Faith was extubated this morning and then coded. It turns out she had a ‘saddle’ clot blocking most of the right main pulmonary artery, which was removed in radiology. As of now, she’s extubated, has good blood pressure, has talked to us and to Josh. Peggy, I can’t believe you pulled this off.”

“Whoopee,” Haley cheered.

There were virtual high fives.

“Gad,” Ann said. “That like to killed me!”

“Ricky, thank you for taking such good care of Josh,” Peggy said. “And you stifled you own distress!”

There was more conversation as they dispersed.

“I am looking forward to a quiet evening with Alicia.” Peggy said.

Emily came up for a more detailed sign-off. “Tell me what I need to do for her tonight.”

“Well, she’s off the ventilator, has communicated with Josh, and is no longer on medicines to keep her blood pressure up. Her morphine will wear off more during the evening, and then she may need more pain medicine. We started her on a heparin infusion, and that will have to be adjusted.”

“No problem,” Emily said. “Are you against using newer blood thinners in pregnancy?”

“No, I didn’t think of them.”

“We use them often in the hospital and in the office,” Emily said. “Heparin and low molecular weight heparin, in my experience, have frequent failures. And I think heparin failed Faith today.”

“I would say that’s correct,” Peggy said. “Good call. Maybe heparin is not the right choice. Can you change her over during the night?”

“Sure,” Emily said, “have a nice night. I won’t call you.”

In the ICU, Josh had not left Faith’s side, and had helped with her care, which is how he thought he earned unrestricted visiting. He had also supervised a blood transfusion on the adjacent patient. Brownie points were handy bargaining chips.

“Josh,” she whispered, “can I have more water?”

Josh put a straw in a Styrofoam cup with ice water. She took it down, one swallow at a time.

“My throat is sore,” she whispered. “My throat is super sore.”

“I’m sure that’s true. Maybe we can get a lozenge.”

He was holding her hand. Except for a single bathroom break, he had held her hand all afternoon, enjoying her fingers and her squeezes. Most of the afternoon, she had slept, and the slow deep respirations had continued. She had been on six liters of oxygen with all pulse ox readings above ninety percent.

In a flash, Natalie came up on Facetime, so Josh held the phone to capture Faith’s face. “Hello, Dr Faith,” she yelled. “Wait, Josh, I want to start recording.” The explosive enthusiasm in Nat’s voice came across well. Faith opened her eyes, and there was a little bit of a grin through sleepy eyes, tape marks on her face, and a dry mouth. “Yeah, Dr Faith. It’s so good to see you.” In short order, the faces of Jim and Marianna also appeared, to which Faith responded with a quiet snore.

“I think she has recovered,” Josh said. “We had to use old slow drugs on her because we were temporarily out of the new short-acting ones. Peggy says she will be wide awake tomorrow.”

“We don’t care,” Natalie replied. “It’s a miracle we have her at all!”

Josh choked up. “Yes, we’re lucky to have her. Or we could have her with brain damage or kidney failure. It looks like she escaped both of those. And we still have Cori.” He put the Doppler on Faith’s belly so they could hear Cori’s heart.

Natalie was quiet. Josh kept Faith’s face on the screen. Finally, Josh spoke up in a normal-sounding voice. “Jim, may I please marry your daughter?”

Jim stammered, a notable first in Josh’s memory. “Natalie, Marianna, is it OK if Josh marries Faith?”

Natalie was already squealing. “That is the sweetest thing, Josh! I’ll be glad to have you as a brother-in-law.”

“Yes,” was Marianna’s only word.

Jim didn’t say anything. Natalie prodded him, “Is it OK, Dad?”

“Yes,” he said. “Josh, I would be glad if you married my daughter.”

“Thank you, guys,” Josh said. He still had Faith on the screen.

“Get in the picture with her,” Natalie insisted.

Josh complied, smiling at the family on the screen. Returning to the side of the bed Faith was facing, he restored the screen to her face. “I’m so happy,” he told them. “This was such a day. I thought I lost her. I don’t know what I would have done.”

“Or us,” Jim agreed. “We were glad you didn’t call until it was over. You told us it would be late afternoon before you would know if she was off the ventilator, so we weren’t even concerned. Then when you called and told us what had happened, we were floored.”

“I’m so glad things went well,” Natalie said. “When will she get out of the hospital, and when will you bring her here?”

“She’s not out of the woods, yet, Nat,” Josh said. “We have to get her blood thinners regulated, help her regain her strength, and watch for other complications. Many COVID patients lose a lot of muscle strength and are fatigued. They don’t seem to just pop back.”

“Well, keep talking to us, even after she starts calling us,” Natalie begged. “Call us when she’s not around so we can ask you questions.”

“OK,” he promised. “I can do that.”

More giggling was heard, followed by whispering. “We’re OK with all that,” a cheerful Jim replied. “Take care of yourself and thank you for all the care you gave her.”

“My pleasure.”

Chapter 40

Josh had sent a text to Peggy suggesting that it was time to confront Faith about Brian. Faith was now officially out of ICU sitting in a chair. Peggy dressed up and entered the room, finding a chair next to Josh. Faith had been crying, and was holding a tissue.

“I told her,” Josh said. “We just need to talk for a while. Maybe you know more about Brian’s problem that we do.”

“Not more than I knew when I talked to you before.”

Faith was staring at her with wide eyes. “Was he sick?”

Peggy said, “I guess so. Pain management, which includes psychiatry and anesthesiology, had planned to admit him with depression. He had successfully detoxified and was making progress. I don’t know what triggered the admission, but he visited the Pain Management that afternoon, the admission was arranged, but then he didn’t appear.”

“Detoxified?” Faith asked.

“Yes. He had an opiate problem, started when he had knee surgery. He was on Percocet and fentanyl.”

“That was a long time ago. He was on opiates that whole time?”

Josh recognized that Faith didn’t know this. “You never saw any evidence of that?”

“No,” she said.

Peggy went on, “I guess he failed his basic ob-gyn written for the second time—”

“I knew about that,” Faith said.

“— and Emily and Dr Thompson, the Dean of Faculty, were addressing the opiates and his depression.”

“I’m crushed,” Faith mumbled. “All this anger and mean behavior was opiates and depression?”

“Yes,” Peggy said. “There was a whole team of people working on him.”

She sniffled, “So my divorce wasn’t the cause of this.”

“No, Faith,” Peggy said, “don’t you think it’s the other way around? The divorce is the result of his depression?”

“So, the move to Albuquerque wasn’t my fault either.”

“Definitely not. Albuquerque should have been a good place for him,” Peggy said. “He had a good job here with an opportunity to step up and have a successful career. This might have been a better place to do that than in a dog-eat-dog competitive department, like in Dallas. You are flourishing here, and he could have, too.”

Josh had his arm around Faith. “His affair wasn’t your fault, either?”

“No. That’s on him,” she said. “And I think it’s more than one.”

“See?” Josh said. “His work performance is his fault. The divorce is his fault. It’s not on you.”

Peggy added to the soothing. “Or on his opiates. He made his own choices.”

There was quiet. The couple would struggle through the steps all grieving people must. The only effective treatment is tincture of time.

“I really didn’t see this coming,” she said. “I had no idea he was at this point.”

“Except for angry exchanges, you haven’t had contact with him for months,” Josh said. “Even last summer, you might not have been in a position to identify what was going on in his mind.”

“Maybe—”

“That’s OK,” Peggy assured. “There were plenty of others who were taking him seriously.”

Josh looked at Peggy, “What else do you know?”

“Not much. He was being recalcitrant about his treatment.”

“Yes,” Josh said. “I don’t doubt it one bit.”

“So, you understand what his doctors were up against?” Peggy asked.

“Oh, yes,” Josh said.

Faith blew her nose. “I get that, too. He has always been like that.”

“Don’t you think that stubbornness is a blessing in ways, but a scourge in others?”

“No doubt,” Josh said. “No doubt.”

There was more silence. Finally, Josh finished the conversation. “This was good, Peggy. She and I just have to talk this one out. I am behind her all the way.”

“Josh, that’s so good for her,” Peggy said. “I am behind you also, Faith, and so are your coworkers. We are all stunned by this. It’s a terrible tragedy, but we can work through this. You two are a great pair, are very resilient, and so good for each other.”

“Do you think the pandemic had anything to do with it?” Faith asked.

“Maybe,” Peggy said. “He had uphill battles of his own, since the problem of opiates shouldn’t be underestimated. It is a disease that has a high mortality. He and I compared it to cancer of the pancreas and lymphoma. Adding patient deaths, critically ill pregnant women, and tough medical decisions may not have helped. And he was terrified that you were sick.”

“Did he talk to you often?” Faith asked.

“Yes,” Peggy said. “I wasn’t part of the team trying to treat him, but he came to talk to me in the ‘fellows’ closet.’ He was up and down, as you would expect. The afternoon after they recommended his admission, I didn’t think he was particularly down compared to other times, and I certainly didn’t think he was suicidal. In fact, I asked him. And he was planning to be admitted.”

“That means the death could have been accidental,” Josh said.

“Maybe,” Peggy said. “In substance abuse, it is hard to know. Families rarely see it coming.”

“You never saw any evidence of fentanyl?” Josh asked Faith.

She shook her head. “No. Never.”

The three sat in silence for a long time, each lost in thought. “Thanks, Peggy,” Josh finally said.

“Thanks for coming,” Faith whispered.

“I’ll be back,” Peggy said.

Chapter 41

“I just felt Cori move,” Josh said, taking his hand off Faith’s belly. “I think she likes me.”

“I’m sure she does,” Faith said. “Sometimes she jumps when you talk. I think she knows your voice.”

“That’s cool,” Josh said. He was coming around to a deeper understanding of being a parent. Feeling her move made him even more aware of her as a person. “I will keep talking to her.”

Josh helped Faith get up off the couch. “I’m so weak,” she said. “My muscles still hurt a little.”

“And your voice is still hoarse.”

“I wonder how long this takes to go away.”

“Well,” he said, “I have read months. You lost a lot of weight, and your face is bony. But the way you have been eating, I suspect that will correct itself promptly.”

“We could go for a walk. I wonder if I will ever run again.”

“I think you will. You’ve had the drive and will to overcome other obstacles, so this one won’t be any different.”

“I hope not. I hope my voice comes back.”

“I do too,” he said. “But if it doesn’t, it doesn’t. I’m just thankful I still have you both.”

She hung on to him as they made their way around the apartment and finally to the bathroom. She chuckled, “I’m glad there are handicapped bars in the shower. I don’t know what I would do without them.”

“I could get you a cane, a walker, and a shower chair.”

She punched his arm, “I’m not that bad!”

“No, you’re not.”

“Cori just moved.”

He left her in the bathroom until she called for him. “OK, Grandma Faith, I’ll help you.”

“Smarty,” she said. “It won’t be long. I almost got up by myself just now. In a couple of days, I won’t need you.”

He helped her back to the couch, and sat beside her with his arm over her shoulder. She nuzzled her arm behind his back. “It’s nice to be home,” she said. “I forgot to take my morning blood thinner, can you get it for me? I don’t need any more blood clots.”

“You’re no fun!” He was back in a flash with the tablet and a glass of water.

“Thanks,” she said.

“We sure don’t need that to happen again,” he said. “When you coded, I melted. That was the most horrific experience of my life. If it hadn’t been for Ricky that day, I would have disintegrated, evaporated, or ignited. It took so long for them to get you stabilized, like two hours! I thought the clot removal idea was a clever one, and it worked, but at the time I thought it was a ridiculous, last-ditch effort. We owe Peggy for the idea, the insistence, and the wisdom. Wow. I was sure I had lost you two, and, honestly, I think Ann and Haley thought so too.”

“I don’t remember anything,” she said. “I don’t remember anything from when I told you I was getting worse and Peggy came to intubate me until that morning in this room when we Facetimed my family. There is something I learned, and that is that chest compressions are not good for ribs.” She pointed a finger at him, “Don’t make me laugh.”

“When you’re a little better, we can go spend a few days in Lubbock,” he said. “I’ve never been there, and we can’t go back to work until you’re better.”

“That reminds me, what was Natalie all giggly wiggly about last night?”

Josh got up, scooted to the roll-top desk and returned with a white velvet box. He got down on his knees in front of her, opened the box and said, “Faith Renee Pernitelli, will you marry me?”

She burst into tears, and in a squeaky voice said, “Yes, Josh, yes.” She grabbed a tissue, looked at the box, and said, “You have to ask my dad.”

Pulling his phone from his pocket, Josh retrieved the video Natalie had recorded. She watched as he asked her dad, as Natalie squealed, as Marianne agreed, and as they had to prompt Jim to answer. “When did you do this?” she asked.

After you coded, got back to the ICU, were extubated, and we were waiting for you to wake up.

“That is so cool,” she said.

He took the ring from the box and put it on her finger. “It’s really pretty. I love it.” She tilted her head from side to side examining it. “How did you know what size?”

“Natalie.”

“Of course.”

He kissed her. “I want you in my life forever. I want Cori in my life forever. I’m so happy.”

“I’m happy, too.”

She grabbed him by the neck and pulled him hard. He felt the tremor which had been present ever since she got sick. He wondered if that would go away. At least he had her, and her brain was working. The rest didn’t matter.

Faith couldn’t wait to Facetime Natalie, but she didn’t answer. “This is Tuesday and it’s ten in the morning. I bet she’s in school.”

“Probably,” Josh said. “We can call again tonight when they’re all home.”

“Are you glad Brian died?” she asked.

“What?” he gasped. “That’s quite a question. What do you mean?”

“I guess I mean, are you glad he doesn’t live here?”

“Yes.”

“Has anything changed for you?”

“No,” he said. “Well, maybe. He’s less of a threat. You used to talk about Brian this and Brian that and sometimes it irritated me. I was sensitive. Maybe because I tried so hard to love you and to get you to love me. Now, I don’t feel that way. You are going to be my wife, and you are not his wife anymore. Do you want to talk about him?”

“No, not really.” She twisted the ring on her finger, raised her hand to show it to him and then put it back down. “Yes. I was really shocked when he died. Almost as if he’d been killed in a car crash. I swear I didn’t see any opiates.”

“Can I say something without being offensive?”

“Sure, what?”

“This came from Natalie. You sometimes don’t get the main idea. Your dad said that too, once. I’m thinking it could have been going on and you might not have caught on. It is amazing that you can be so observant and perceptive at work, but in your private life you seem clueless. Sometimes. I’m just saying.”

“That doesn’t surprise me. Natalie has told me that a lot of times, and the last time had to do with a yellow rose. I was clueless.”

“The yellow rose. I couldn’t believe you.”

“Sorry,” she said. “I’m going to watch you like a hawk. I am not going to miss opiates or anything else that could take you away from me.”

“You’re sweet. I love you and I always will.”

“I love you too.”

“I love you too, Cori.”

Chapter 42

The noisy little storm had passed, bringing a few gusts of wind, spectacular lightning, and only a sprinkle of rain, all typical for early summer in West Texas. The air was clean, the breeze cool, and flowers in the back of the Pernitelli home ablaze with color. The setting was perfect for the backyard picnic.

On the grill, Jim roasted chicken, tended potatoes wrapped in foil, and seared zucchini planks. Josh stood next to him, watching the master turn the sizzling meat, the sparkling potatoes, and the soft vegetable, aromas awakening noses and raising expectations.

“Thanks for bringing Faith out here,” Jim said. “We have been dying to see her.”

“I’m sure it was awful,” Josh said. “You couldn’t visit her, even when she was so sick. I’m just thankful for the electronic magic we have.”

“Her ring is beautiful. Where did you get it?”

“I don’t know if I should tell you,” Josh said. “I don’t need it widely known.”

“I can keep a secret.”

“Sam’s.”

Jim coughed and said, “I never would have guessed.”

“Yes. I had been to all kinds of places, Jared, a shop in Old Town, a shop near the airport, Shane Company, Zale’s. They were all ugly and all the same. They just didn’t pop. Then I went to Sam’s for other things and walked past the jewelry display and that one just about jumped out of the case and into my pocket. I just liked it.”

“She didn’t help you pick it out?”

“No. I got it while she was still in the hospital.”

“Didn’t you have to quarantine?”

“I tested negative while she was still in ICU. I was just thankful that Emily didn’t insist I come back to work.”

“Natalie was impressed by the ring,” Jim said.

“I showed it to her in Sam’s that day, and she approved. I proposed and put it on her finger about noon the day I got her home from the hospital. Then we called that night and you all got to see it.”

“It wasn’t as impressive on Facetime as it is in person. You did a good job.”

“How did you buy yours?” Josh asked.

“She helped me pick it out. In fact, that’s how I found out she wanted to marry me. Up until then, I wasn’t sure.”

“Did you just tell me you sometimes don’t get the main idea, Jim?”

A unique smirk answered the question. Jim poked on the grilling food. Then Faith’s change-the-subject face appeared on Jim. “Brian was a shocker. But I guess I’m not surprised.”

Josh said. “It sure took me for a loop.”

“There are people to whom life happens. I used to think that it was because they didn’t want to make life happen, or that they were too lazy. But it’s not true. There are people who just cannot make life happen. They are just not able. In my experience, bad things happen to that kind of person.”

“I had not thought of that before. Peggy said something about us making life happen, but I had not thought about people who don’t make life happen.”

“Yes. There are plenty of them.” Jim motioned toward the door. “I don’t think there are any in this house. At least I hope not.”

Natalie and Faith emerged onto the patio to set the table, adorned by a vase with flowers brought by Josh, a lively tablecloth to complement the weather, and Saguaro cactus place mats. Plates, silverware, and condiments found their places.

The family sat to eat. “I’m so thankful to be together,” Jim revealed. “I realize that it might not have turned out this way. It’s hard for me to explain my relief that I still have two daughters.”

“We’re going to have a son-in-law,” Marianna added. “I’m happy we have Josh, that he didn’t get sick, and that he took such good care of Faith.”

Neither Josh nor Faith could speak. The restored health, the closeness of family, and the peace of home was enriching and rejuvenating, but at the same time overwhelming.

Natalie said, “Yes, I’m happy I still have a sister,” but she couldn’t avoid the stinger, “I guess.” There were giggles. “But I’m even happier that I’ll have a brother-in-law who I can depend on to take care of Faith. We get to plan a wedding.”

That lifted the timber of the conversation, bright smiles emerging on faces. “Yes,” Marianna said, “it will be fun to plan a wedding. When were you guys thinking this should be?”

“I don’t know,” Faith responded, speaking with her raspy voice. “We’re going to have a baby on September 22. Either we need to get a move on and get it done quickly, or we need to wait until October.”

“The weather is nicest in October,” Jim said. “July doesn’t strike me as the time to have a wedding in New Mexico or West Texas.”

“I think it should be outside,” Natalie said. “Then it doesn’t matter where we have it or how many people come.”

“We could have it in Angel Fire, or Cloudcroft, or—”

“Mom,” Faith said, “we need to have it where the people we invite can come. We weren’t thinking of a big crowd. We have to remember the Clinton half of the family, and all our friends in Albuquerque.”

“Are there others we should consider?” Marianna asked Josh.

“No. We don’t have a big family.”

“What about us, Jim?” Marianna asked. “My sister and her kids might like to come. We haven’t seen them in a couple of years. Their kids have all grown like ours.”

“Oh, gross,” Natalie said. “Julian and Devon? Creeps!”

“They’re family, Natalie,” Marianna said.

The talk wandered to talking about the residency. “It seems like your residency is hard work,” Jim observed. “Will there be time off for this?”

“We hope so,” Faith answered. “We hope we still have vacation time despite our long absence. Supposedly we only have five sick days per year, and we both used up a whole lot more than that.”

Josh said, “I haven’t talked to Dr Beacham about it, so I need to do that. Even if we only get a few days, it would still be manageable. Faith needs maternity time, too.”

“I think if we miss too much time, it counts against our training time requirements,” Faith added. “I haven’t checked that out either.”

Faith struggled to her feet to help her mother clear the table. Josh rose to help, but Natalie grabbed his shirt sleeve and pulled him back down. When Faith and Marianna were out of earshot, Natalie asked, “She’s so weak and skinny. Will she always be this way?”

“No, Nat,” Josh said. “She will get stronger, and her bony face will soften like it was before. She has been eating well and she is getting agile.”

“How long will that take? Maybe we don’t have a wedding until she’s better.”

“I don’t know. I hope it won’t be long. She will improve faster than you can plan a wedding. Did you see what she ate here today?”

“Uh, yeah. I did notice that.”

“She’ll bounce back just fine.”

“Her voice is different,” Natalie said. “Will it always be like that?”

“I hope not,” Josh said. “But if that is the only scar from this misfortune, I’m happy. It could have been so much worse. I’ll take what I get.”

“Yeah.”

Dessert arrived at the table with Faith and Marianna.

“Carrot cake?” Jim exclaimed. “I didn’t know the party was for me! What are you guys having?”

“You don’t get it all, Daddy,” Natalie said. “I’m having a lot!”

The cake was served, all agreeing that it was superb. It was Josh’s first experience with the famous family recipe. “Oh my gosh! This is so good it’s dangerous.”

It was a family favorite, and undoubtedly Faith had not had any since July, but she kept cutting pieces off and gobbling them up, under Natalie’s watchful eye.

“I am sorry about Brian, Faith,” Natalie said.

“Boy, that was a kicker,” Josh said. “I didn’t see that coming.”

“Neither did I,” Faith said.

“You know,” Jim said, “your marriage might have been a victim of his problem. Which I didn’t know he had.”

“You never liked him, Daddy,” Faith said. “Maybe I should have taken a message away from that. Don’t marry someone your father doesn’t like?”

“We like Josh,” Natalie said. “We want you to marry Josh.”

“Yes, Faith,” Jim said. “Please marry Josh. Bring us Cori.”

“Oh, Cori,” Marianne said. “Bring us Cori. I am so excited about Cori. I even bought some clothes.”

“Mom, did you really?” Faith asked. “Let me see them.”

In a moment, Marianne returned with bursts of pink, frills, and lace. “Look at this. I am so proud of these. And look at this one! Here are some socks.”

Josh scooted closer to Jim. “How long does this last?”

“About twenty years. More than that if you have two daughters. Get used to it.”

“I will. I don’t mind it a bit. In fact, I am pretty excited myself.”

“I was too,” Jim said, “and I enjoyed every minute. My favorite moments were teaching them to ride a bicycle, taking them out on dates, going to their science fairs or soccer games, and teaching Faith to drive. And the prom. I have driving and the prom ahead of me for Natalie.”

“I noticed the pride on your face, Jim. I hope I get all that pride and joy also.”

“You will. I’m sure of it.”

The afternoon ended bittersweet with the long ride back to Albuquerque looming. Tearing away was arduous and slow, with tears and smiles, well wishes and sarcastic quips, handshakes and hugs.

The next morning, they were at work. The pandemic was beginning to wane, although schools and the University classes had remained cancelled. The streets were becoming mildly more populated. Face masks were everywhere, with awesome patterns, colors, and decoration. Churches, schools, and universities were still meeting online or attending inside cars. A second wave was predicted with no definite expectation of when that would be.

Peggy arrived with her overnight satchel, anticipating her last call night. A permanent faculty member had been recruited and was expected to start in the coming days, whom Emily had boasted would be an excellent addition to the Division.

Ann McCauley looked at her. “What are you going to do now?”

“Retire. I’m old, fat, diabetic, and I don’t have the energy to keep this up. This was my last hoorah.”

“Gad. Are you sad?”

“At the beginning, yes. Now, not at all. I was proud of all the things I had learned to do for people, and it took me my whole life to develop that level of skill. I was devastated when I suddenly had to leave it behind. But you guys were so enjoyable and so uplifting. I got to spill out buckets of things I had in my brain that I needed to impart on someone. Now, I’m tired, I want to spend time on grandnieces, with my wife, and with my community. Once in a while, I want to get up in the morning and think, ‘What am I going to do today?’”

“That’s so nice,” Ann said. “Most are chomping at the bit to get out when they get to retirement age and can’t think of anything but vacations or motor homes. Your view is more fulfilling and more peaceful.”

“Thank you for that. Fulfilled and peaceful is exactly how it feels, and how I needed it to feel.”

“We appreciate the pearls of wisdom. We’ll all benefit, and I predict we’ll all pass the pearls on down to people who didn’t know you.”

“Well thank you. Thanks so much.”

“Did the scourge leave any scars?” Ann asked.

At this point Josh decided he needed to listen, and Ricky approached.

“When Faith coded, I was dashed. I didn’t see it coming. She was so difficult to resuscitate that I had to filter through a raft of possible problems. I wondered how I was going to manage. I kept thinking about what I would tell you, Josh, her family, and Emily. Thankfully, a clot was the right diagnosis, the radiologist thought he could get it out, and it worked. I still dream about it.”

“We’re thankful you pulled it off,” Ann said, “although I didn’t think you would or could. I thought the radiology idea was off the deep end, but I am sure glad you tried it. Like you said in the ICU when we were all shocked that you wanted to move a patient that is still coding through hallways and elevators, that if we stayed in the ICU it wouldn’t end well. That was the truth, even though I was having trouble accepting it.”

“Did this leave you with any scars?” Peggy asked.

“Yes. Jenessa and the cesarean section.” Ann wiped a tear. “I don’t know why she is branded on my soul, but she got to me. When Ricky told me what you two had discussed, I was speechless. I hadn’t even thought about it. But the way it turned out, I will never forget it, and I will always think of it when I have a maternal death with a viable fetus. We have those, occasionally, especially auto accidents with head injuries. I will always think of it.”

Ricky spoke next, “Jenessa was impressive, I admit, but my scar is Reyenne. I held her hand as she just faded away. She was the first patient I had cared for who died, and she was the first one I had actually seen die. There was nothing to do, and I was so angry at Brian Yankton because we couldn’t find him. She is burned on my soul.”

“Mine is Melanie,” Faith said. “I was crushed the morning that I found out Reyenne had died, but I was there when Melanie died. All I could think of was that she was leaving three kids behind. I will always remember her. Peggy, you said you dream about me? I dream about Melanie, and the dreams keep me awake.”

“I think we all matured and benefited. It may have been a horrible way to learn some of the things we learned, but it shows that learning goes on forever, and you can’t always tell what form it will take.”

The chatting stopped when rounds began to look organized.

“Look, everybody, Faith is here,” Haley said. “It is nice to have you back. We were afraid we might have lost you.”

“Just for the record, I’m glad they’re here too,” Josh said.

“They?” Haley asked.

“Cori’s jumping!” Faith said.

“Well, yes. Cori. What’s this?” Haley asked, pointing to a lump under Faith’s glove. “What happened? Tell us all about it!”

Faith grinned, held her hand up for Haley to inspect. “Josh and I are engaged,” she said.

There were congratulations and accolades. Faith pulled her glove off to dazzle everyone with the ring Josh had given her.

“What did your parents think?” Peggy asked.

“They are excited. Especially Natalie.”

“When is the wedding?” Haley asked.

“We don’t know.”

“When did Josh pop the question?”

“To my family, the day I coded. To me, the day I was discharged from the hospital.”

“How far along are you now?” Haley asked.

“Twenty-two weeks.”

“What’s her name?”

Faith paused to optimize the suspense. “It’s Cori.”

“Cori is nice,” Haley said. “I’m glad you didn’t name her Corona.”

“What was the worst part?” Ricky asked.

Faith rolled her eyes. “The chest pain. I still have to be careful how I move. Let me tell you, chest compressions are not good for ribs.”

“We’re glad to have you back,” said Emily. “I know this has been a distressful ordeal for everyone. The long hours, extra shifts, the deaths, the ICU, Faith and Josh, and medication and supply shortages. I am proud of you all.”

“Oh Faith, I wasn’t sure you would pull through,” Ann said. “I am glad it turned out good. I was afraid of kidney failure and brain damage.”

“Haley got the brain damage.”

“Shut up Ricky.”

Rounds were succinct. After disbanding to their individual duties, Emily pulled Peggy aside. “I am thankful you were here. You saved us, and I think you saved Faith, too. I wish you would stay.”

Peggy shook her head. “I am thankful you had me come. It was good for me. I am so happy Faith pulled through. That was the afternoon to remember.”

“Please stay another year?”

“Gosh, Emily, I need to be a great aunt, aunt, spouse, and citizen of my little Crystal Springs. I appreciate the offer and am flattered. But I am ready for the next phase of my life. Besides, you have a real maternal-fetal medicine specialist coming to work and she’s not even a fresh graduate.”

“But I need two to—”

“You have given me a gift beyond what you can imagine. I took this offer on a whim, but in the end, you have transformed a grumpy, unhappy old woman who had been forced by brain and body to retire from something she loved, and turned her into a satisfied, peaceful, content retiree with self-worth. I thank you for that.”

“Well, thank you,” Emily said. “If you change your mind…”

Acknowledgements:

Thanks to Jean Scanlan, who got me started writing these books. Thanks to Ed McClelland and Martha Hinson who read and helped revise and perfect the narrative. Thanks to Derek McIlfresh and Andy Ross for content editing.

Thanks to the coronavirus epidemic of 2020 which provided the time and material to write this book.

Special thanks to all the health care providers who, unlike me, took care of patients who were not only critically ill, but also a lethal threat to themselves. While not in this fictional account, nurses, respiratory therapists, pharmacists, laboratory technicians, radiology technicians, environmental services, administrators, accountants, security personnel, and others contributed in crucial ways. Their contribution is not intended to be diminished by this account of physicians battling COVID. I hope others will write accounts, both fictional and non-fictional, emphasizing some of those crucial caregivers, about whom I am not qualified to write.

Tony Scott, MD

April 1, 2021

About the Author

Dr Scott is a retired obstetrician and anesthesiologist who grew up in Colorado, went to college at the University of Colorado, and went to medical school at Washington University in St Louis. He completed a residency in anesthesiology at Bowman Gray School of Medicine (Wake Forest University) in Winston-Salem, North Carolina, and an obstetric and gynecology residency at Columbia University in New York City. He practiced for forty years. He currently resides near St Louis.

Copyright

This is a work of fiction. It is inspired by actual events and written to be as realistic as possible. The plot, the characters, the clinical appearances, the story, and the outcome are fiction. No real event or person is described.

Copyright 2020 by Tony Scott, MD

ISBN: 979-8-6378-3309-2

Content

Tony Scott, MD
ALONG CAME COVID
LOVE AND LOSS IN THE 2020 PANDEMIC

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Chapter 24

Chapter 25

Chapter 26

Chapter 27

Chapter 28

Chapter 29

Chapter 30

Chapter 31

Chapter 32

Chapter 33

Chapter 34

Chapter 35

Chapter 36

Chapter 37

Chapter 38

Chapter 39

Chapter 40

Chapter 41

Chapter 42

Acknowledgements:

About the Author

Copyright