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On the first weekend of every June, the Mohawk Valley Hospital had a fundraiser. Members of the executive medical staff sold tickets to dinners in their homes. Proceeds went to the hospital foundation, which paid for lobby curtains, new seats for waiting rooms in Emergency and Radiology and Labs, a children’s ward mural.

        Some dinners had elaborate themes: Polynesian night, when guests wore souvenirs from trips to Hawaii and Tahiti; pioneer night, when guests dressed in faux homespun from Vietnam; Austen night, when guests dressed as Regency rakes and belles. Dr. Dobson was medical staff vice president; he and Marianne had hosted a Mexican night every year since a Puerto Vallarta vacation.

        Dr. Francis Delisle did not want to go.

        “You don’t have to want to go,” said Ginny. She had on a china poblana skirt and a white blouse embroidered with red roses and gold eagles. “You just have to go. Dobson’s your partner. And don’t wear a tie. You’re supposed to dress like a Mexican.”

        He had on a white shirt and skinny navy tie. “I’m going as Carlos Slim.”

        “You’re slim, all right. Are you losing weight?”

        He pulled on a gray blazer. She shook her head.

        “You’ll stick out. Then you’ll feel more uncomfortable.”

        He always felt uncomfortable. “A tie around my neck reminds me I’m not among friends.”

        “And who are your friends?”


        “Me and who else?”

        He thought. “You?”


        They went to the car. “If I died, none of these people would miss me.” She was hunting in her purse for keys, almost listening. “Dobson would be pissed he’d have to cover my clinics and call. For the rest, I’m the name on a consult request, nothing more personal than the head of a spreadsheet column.”

        It was still light enough to read in the passenger seat: Francis opened that week’s Journal of Clinical Oncology and tried to learn new ideas in immunotherapy. Across the road as they turned out of their driveway, Bill Noland’s new corn was up in long green rows.

        Ginny drove by the old houses under the bluff and by Carmen DiFranco’s factory, where his people made specialty pasta with organic wheat that he sold to Wegmans and Whole Foods and storefronts in Canandaigua and Woodstock and Tanglewood.

        “What is it?” she asked.


        “You seem more distracted than usual.”

        He folded the journal in his lap. “That would be extreme.”

        She missed the joke. “So?”

        He shook his head. “A cancer case.”


        “I think so.”

        “Someone I know?”

        “You’d think so.”


        He turned pages in his journal without finding an answer. They passed the white sign with the name of the town just past the cabinetry shop where Tomasz Hreschyn and his son made furniture from local lumber in a style part Shaker and part Bauhaus, sold in showrooms in Connecticut and Westchester and Boston. They went by the glass factory, where refugees from Steuben blew neon-colored glass into arabesques with two apprentices in the back of what had been Nicholson’s Men’s Hats, where the windows were filled with display pieces like the ones in Cambridge and a boutique in the Meatpacking district.

        “We’re almost there,” he said. “When I know more, I’ll tell you everything.”

        They walked up the drive, past parked luxury cars from Germany, Sweden, and Japan. It was the Sewell mansion, built by an inventor of railroad brakes who’d died in a trainwreck. Dobson had bought the place for Marianne, the physical therapist he hadn’t yet married. Francis could see where they’d had the mansard roof slates and rotted joists replaced. Dobson had insisted on those new triple pane windows.

        “Be civil,” warned Ginny. Then she rang the bell.

        Marianne wore an orange and blue rebozo. She had an air kiss for Ginny, a handshake for Francis. She led them past the oak staircase and across the marble entry floor to the parlor parquet. In a cartoonishly large straw sombrero with a red, green, and white band, Dobson was ladling margaritas from a huge punchbowl.

        “Como esta, hombre?” Dobson spoke Spanish without accent marks.

        Francis shook Dobson’s hand. “Estoy orgulloso de presentarme otra vez para celebrar con mis compadres la cultura mexicana,” he said.

        “Nice,” said Dobson. “I forgot you spoke Spanish like a wetback.”

        “I said I’m proud to be here.” He didn’t try to translate the irony.

        Dobson grinned. “Love it.” He handed Ginny a green tumbler with salted rim. “Margarita?” He winked at Marianne. “That’s about all I remember from two years of high school Spanish: margarita, cerveza, and ‘Donde esta el sala de bano?’”

        “La sala,” Francis corrected.

        “Whatever. Would you rather have a shot of tequila?” He drew air quotes with his own margarita glass in one hand and winked.

        “Just ginger ale,” Francis said. “No ice.”

        “A sound choice for a man on call.”

        Ginny led him among the half-drunk faces that turned to watch them. “Try,” she whispered.

        They circulated. He tried. He dredged up acceptable topics for conversation. The weather had been good. Fields had dried early and the plowing had started. The hospital’s new CEO had promising ideas: a women’s center, a wellness center. Eichelberg the surgeon reminded him Medicaid expansion only meant there were more patients whose care never paid enough to bill, though everyone did anyway. News from the world was worrying: war in the Middle East, unrest in Africa, markets volatile. With the governor’s tax incentive, a Dailan conglomerate might have bid on the riverfront complex if the copper hadn’t been stripped out. Arsonists had burned the empty McCaverty farmhouse, or maybe it had been a McCaverty. Carter Simpson’s family medicine group had sold their practice to the hospital. A new radiologist, Hershey-trained, was living in the development that had been the Naughton farm.

        Francis, hungry for a drink, had a second ginger ale, then a third.

        “Have you told her?” Dobson asked. Ginny was with Marianne in the buffet line.

        Francis put a hand to his throat, where Dobson’s needle biopsy of a supraclavicular lymph node had diagnosed an undifferentiated cancer; they were waiting on Eichelberg for definitive biopsy. “I’m waiting for the moment.”

        Dobson rolled his eyes. “You’re an oncologist. You know there’s no right moment.”

        Francis took his plate out back, to the brick patio. Marianne had hired a tent. Ginny was at a white wicker table under the new leaves of the great tulip tree that shaded the yard. The light had almost gone out of the sky.

        “You doing okay?” she asked.

        “Fine,” he said, carving tamales and a reasonable effort at machaca with a plastic knife.

       Dusk had fallen. A luna moth flew into a floodlit swarm of insects under the eaves. When his plate was clean, Ginny took his hand.

       “Back into the fray.”

        They listened to doctors complain about the hospital’s new electronic medical record. Brigid Carter, in a hippie poncho and huaraches from Tijuana, she decried the elimination of Advanced Placement English and Calculus at the high school after the bond issue’s defeat. In an embroidered green charro jacket and red leather sombrero, Joella Ricciardi carped about the prices and quality at Marty Walenson’s boutique, which of course everyone had to patronize because it was the last in town.

        Carhardt the pathologist found them on the edge of the patio. He was alone.

        “Todo esto te deja bien aburrido también?” Carhardt asked.

        “Por supuesto,” Francis said. “Charlando de nada con personas que no puedo respetar, comiendo comida tipica falsa. Tan agradable.”

        Ginny was looking at them blankly. People were staring.

        Carhardt laughed. “Igualmente,” he said, then: “Where’d you get your accent?”

        “It’s only high school Spanish.”

        “No. You’ve traveled. Medical work?”

        “Honduras. One summer at a mission hospital. You?”

        “Ecuador. I tried helping a team that failed to develop a Pap program in Quito. Good idea, but the Quechua women in the barrios and pueblos—the ones who got cervical cancer—couldn’t afford the service. Been back?”

        “There was a woman involved.”

        Then it was time for dessert.

        “Who was she?” asked Ginny.


        “The woman in Honduras.”

        “She was before I knew you.”

        As they stood under Japanese lanterns in the tent, Vic Fassone came over to solicit free advice from Ginny about a Chinese internet aggregator.

        “That’s the tequila talking,” Ginny joked, fingers light on Vic’s wrist. “If you have a serious question, I have office hours from eleven till six Tuesday through Friday.” She took a card out of the red and black leather purse she and Francis had bought at a street fair on the slope below the Recoleta. “I can do some research and get back to you.”

        “But I don’t want research,” said Vic. He put his arm around her. “I just want to know what you think.”

        Ginny shrugged out of his grasp. “I think you’d be better off putting your money in a hole in the ground.”

        As soon as was decent, they looked up Marianne.

        “We’ve had such a wonderful time,” said Ginny. “Every year, you outdo yourself.”

        “It’s nothing. Everything’s catered.”

        “Still, it must be such a burden, cleaning up before and after.”

        Marianne waved them off. “We hire help for that, too.” She took Ginny’s arm. “We use Bart Withers’ service. Nobody under forty—very thorough. Who do you use?”

       “Oh, we manage.”

        Francis drove back. Ginny slumped down in the passenger seat, although she’d had only three of Dobson’s margaritas and a Sambuca with dessert.

        “God, I can’t drink like I used to.” She touched his right knee, which would once have been an invitation. “We’re getting old.”

        “My patients say the alternative’s worse.”

        “Enough about your patients. You wanted to talk about something?”

        “I . . .”

        She let it go, content just to be massaging the inside of his thigh as a little cone of the world unspooled in front of the headlight beams.

        Later, they undressed together. Her kiss tasted of anise and chocolate. He pulled down the sheets and set her back on the mattress. Then he got up.

        “What is it?”

        He shook his head. “Something I have to work out.”

        “Who could it be?” She named off friends, people they knew who were not friends, people. Her voice went dreamy. He got into bed from the other side, still in his white shirt, though his tie was back on the closet rack. “Not even close. It’s just that . . .” She had her right leg across his body, right arm over his chest, head on his shoulder, asleep.

        After a time, he got up, pissing away ginger ale. Then he slept, too—for two hours before his pager went off: the emergency room, his patient, hemorrhaging, so the doc on call called him and Evans the gynecologist at once. That was how it was done: when faced with something very bad, a good doctor made it someone else’s problem.

        She was on a gurney in a side bay, past cast and cardiac rooms, past trauma stabilization, to where staff stashed patients who probably didn’t need admission as their illnesses evolved, where they hid the dying so other patients and families wouldn’t see. She was one of those.

        Still, they were working hard on her, Evans and a nurse. They had exam stirrups on the gurney and the nurse was handing Evans forceps and gauze. Evans was packing gauze up the woman’s vagina as tightly as he could, and still the blood was running onto sheets and onto the towels on the floor and onto Evans’ shoes and the cuffs of his scrub pants and onto the gurney wheels and onto the steel gurney frame and onto the tiles of the floor beyond the towels. It was bright blood. While it ran through the pack, another nurse was hanging a transfusion on the IV pole above the woman’s head, and blood ran down the plastic tubing and into a big-bore catheter in the woman’s arm. Dr. Delisle saw it was whole blood, which meant Evans was desperate. And he saw it wasn’t enough. Evans quit packing.

        Dr. Delisle knew the woman’s history: Annette Pugh, married thirty-four years to a dairyman on the plateau south of the Mohawk Valley, had skipped Pap tests. Irregular bleeding at 53, which she’d assumed was menopause, was Stage III cervical cancer. She was treated in Albany with radiation and chemotherapy and entered remission. After fifteen months, she started bleeding again. The surgeons in Albany offered a procedure, but she refused the requisite stoma bags. Chemotherapy with Dr. Delisle had stabilized her cancer for eight months. Now she was hemorrhaging.

        “I can’t stop it,” Evans told him.

        “Can you suture it?”

        Evans gestured at the blood on his shoes.

       “There’s nothing in there but radiation scar and cancer. No stitch would hold. It’s eroded into an artery.” He scuffed at the floor with one toe.

        The smell was terrible, dead meat, iodine, and blood. Dr. Delisle took Mrs. Pugh’s hand. She looked up at him.

        “Am I dying?”

        He squeezed her hand in both of his. “Yes.”

        “Isn’t there anything you can do? Isn’t there anything anybody can do?”

        He glanced at Evans, who shrugged, then back at her. Dr. Delisle shook his head.

        She turned away. “My God.” She looked back at him. “I don’t know if I can do this.”

        Dr. Delisle rubbed her fingers. “Do you want your husband?” He looked to the nurse by the gurney’s head. “Is he here?” The nurse nodded.

        “No. Christ. He couldn’t handle childbirth. This? Never.”

        So he was left to hold her hand alone.

        “At least it doesn’t hurt,” she told him.

        He understood it was a question. He put his hand on her shoulder and looked into her eyes. “If it does, let me know. We can give you something.”

        They took her legs out of the stirrups. Blood welled up under the sheet and through the blankets the nurses wrapped her in. Dr. Delisle watched the color fade out of her dairymaid’s cheeks. It did not take long.

        “Do you need anything?” She shook her head.

        Then she said: “I’m thirsty.” A nurse went out for a paper cup. When she came back, Annette Pugh was dead. The nurses looked to him. Evans had gone for a stat delivery. Dr. Delisle took out a stethoscope and listened to the silence inside Mrs. Pugh’s chest.

        They had Mr. Pugh in a waiting room without windows. He still had on mucking-out boots, and the cowshit on his coveralls hadn’t dried. When he looked up and saw the news in Dr. Delisle’s eyes, he raised his hands to his face and wept.

        Dr. Delisle put a hand on Pugh’s shoulder. “I’m sorry.”

        Pugh shook his head. His sobs choked him. He took a huge breath.

        “You don’t understand,” he said. “I can’t.” He looked up through tears. “Not without her. A hundred and twelve Holsteins. I just can’t.”

        Dr. Delisle rubbed Pugh’s shoulder. “You’ll think of something.”

        He had checked Mrs. Pugh’s admission paperwork crossing the ER, in anticipation of this: she was Episcopalian. “I’ll get Father Drummond. He’ll pray with you.”

        Then he went out onto the ambulance ramp to make that call. The sun was well up. The robins were boisterous. Father Drummond said he’d be in momentarily. Dr. Delisle still had seventeen people to see in clinic before noon.

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