Souvenir (15 page)

Twenty-one

M
EG COULD NOT HAVE BEEN MORE SURPRISED TO FIND
C
ARSON AT THE
tailor’s. He was the last thing on her mind this afternoon, while she squeezed in yet another errand for Brian before heading over to her one-fifteen appointment with an old med school colleague, neurologist Brianna Davidson—Manisha had insisted she call Brianna and ask to be seen right away. “Answers are always better than questions,” she’d said.

The start of the day had been tense, Brian waking up hung over and unwilling to talk about the money and his coming home drunk. But then he’d called her at ten-fifteen and sweetly asked if she could get his suits and drop the gray one by his office; he was leaving for Boston right after work.

She heard Doreen in the back room asking Pete, “I am getting Mr. Hamilton’s suits—where jou have put them?” and prayed they’d be found, fast. She knew she should say something more to Carson, but what? Where to even begin?

“How do you know about this place?” Carson said, and she was hugely relieved that he was able to dredge up a casual remark, because she was tongue-tied, awkward in his presence in a way she’d never been before.

“Oh. He—Brian—heard about it from somebody, God knows. Pete’s very good.”

“Yeah, I’ve been coming to him for a long time.”

“Oh, terrific.”

“Yeah.”

He looked so good in person. She’d seen his face on CD covers and magazine covers and, thanks to Kara, in the newspaper, and always he looked appealing—well, wasn’t that the job of those photographers and stylists? In person, though, he had a presence now, a kind of vibrant energy that resonated around him. His hair was longish and rumpled, much like it’d been when they were teens, and a flock of light brown whiskers grew from his chin, no fuller than when he was twenty. He rubbed them.

“So…” she said, taking her turn, “is your mom well?”

“She’s great! Yeah. She’s, um, keeping busy…”

The beads swished. Meg looked over, expecting Doreen, but seeing James McKay instead. How funny she and Carson must look to him, her standing there clutching her purse to her like a life vest, Carson with one hand at his chin and the other jingling loose change in his pocket. Awkward kids, struggling for words.

James came over to her. “How are you, Meg?” he said, leaning in to kiss her cheek.

“All right, all things considered. Dad’s getting used to retirement over there at Horizon.” How much easier it was to talk to James!

“Good, good,” James said. “Give him our best.”

“I will, thanks. You look well.” She’d seen him several times since her split from Carson, most recently at her mother’s funeral. He and Carolyn both attended. James had been warm and sympathetic, Carolyn sympathetic but also aloof, as she always was when their paths crossed. Meg had never taken it personally; she understood Carolyn’s protectiveness, understood what she must think of a woman who would just casually rip out her son’s heart and stomp on it, as Meg had seemed to do.

Carson had sent her father a card, or so she’d heard.

James moved to Carson and put his arm around his shoulders. “I’m plugging along,” he said. “Making sure Carson keeps the wedding plans on schedule.”

She saw the sideways look Carson gave his dad, who she could tell was playing the protective parent himself just now. Did James see her as a threat? Some instincts died hard, clearly—her own included, because she hadn’t been able to help her first reaction to Carson, the sudden tightness in her chest, the immediate urge to press herself against him, her shoulders fitted into his armpits when he wrapped his arms around her. He had held her so many times, for comfort, for support, for protectiveness, for desire…she’d lived in his arms, grown up there.

She made herself smile, her professional smile of assurance that everything was under control. “So when’s the big day?” she asked.

Carson said, “Next month—Mother’s Day weekend, in St. Martin. Sounds weird, I know, but her mom—Val’s mom, she liked the idea of combining the two things.”

“Sure,” Meg nodded, recalling too well how her own mother-in-law had steered so many of
her
wedding plans, taking the helm as if the fact of the Hamiltons paying for the wedding granted Shelly the right to plan it all. Her mother accepted the role-reversal gracefully—gratefully, in fact, which irritated Meg at the time. She wanted to tell her to have some pride; she, Meg, was also doing
them
a favor, by allowing Brian to marry the girl he wanted most. The money being thrown around, the Hamiltons’ wealth, that was a
tool
, not a scepter, and she wanted her mother to recognize this. But with her own limited ability to see the bigger picture at that age, she hadn’t understood the dynamics of the situation. Her parents were, in essence, selling her off, just as some families in other cultures sold
their
daughters, as a way to improve their own circumstances. The seller might be able to fetch a high price because of some desirable quality in the daughter, but it was the buyer who could afford that price who truly held the power.

In the case of Carson and his bride-to-be, the situation surrounding their wedding was, of course, much more usual. Valerie Haas might not have quite the wealth Carson likely did, but there was no “sale” taking place. Envy prickled the back of Meg’s neck as she thought how it must feel to Valerie to be marrying a man for no other reason except that you loved him.

Oh, she’d been
fond
of Brian when they got married—had told herself she would never have married him otherwise; that would be a fool’s bargain. She forgave his main defect: that he wasn’t Carson. She hadn’t
loved
him, though. Love, she’d told her mother, would come in due time—no different than with arranged marriages, she’d said. “Of course it will,” her mother agreed. “Why shouldn’t it?”

Doreen reappeared, carrying Brian’s altered suits, and passed them to her.

“On jour account?” Doreen asked.

“Yes, thanks.” Meg nodded. She was just about to tell the men she had to run when the beads parted again and a trim, white-blond young woman appeared.

“I think we got it!”

Carson jerked around like a kid caught reaching for a cookie right before dinner. “Oh, good,” he said. He looked at the woman—Valerie, obviously, for not only did she look like the bride-to-be in their engagement photo, she had the lithe body of an athlete in her prime: smooth, long leg muscles bared by shorts like the ones Savannah slept in, curved biceps displayed under the same type of meager sleeves Savannah’s formfitting tees had. Carson looked at Valerie as if unsure of his next move.

James saved him. “Val, this is Meg Hamilton, an old friend. Her folks used to own the farm next to ours.”

“Hey,” Val said, raising her hand up in a quick wave. Her friendly look told Meg that Carson had spared her the details of his young adulthood—or one particular detail anyway.

Meg said, “Glad to meet you,” as warmly as she could—which was lukewarm. Not bad.

Val, obviously distracted by whatever it was they
got
, didn’t notice either way. She turned to Carson. “Pete and me, we’re simpatico on the tux design. You guys are going to look
fab
.” She held both hands out in a thumbs-up gesture for emphasis.

Fab, Meg thought, watching Val snake her arm around Carson’s waist. The bride-to-be looked smaller next to him, no more than five feet three inches and two thirds his width; she was
fab
herself, with that gleaming hair and golden tanned skin. Well, what else would she be?

Meg remembered suddenly to check the time, and saw she really did have to run if she was to make her appointment with Brianna. “Sorry, but I have to go. I’m on my lunch break.”

“Of course,” Carson said.

End it quick.
“It was good to see you—and congrats again.” She shifted the suit hangers from her right arm, which was feeling very tired, to her left, then turned for the exit. James hurried ahead of her to hold the door.

“Thanks,” she told him, stepping out into the blazing sunlight. She tried to raise her hand up for her sunglasses, but it had become leaden, just like before.

James didn’t notice anything. “Take care,” he said, and let the door close as he returned inside.

Meg squinted as she went to the curb, then waited for traffic before crossing to her car on the opposite side of the street. Something clicked in her mind: the wedding was set for Mother’s Day weekend, Carson said—not Mother’s Day itself, then, but the day before. Savannah’s birthday. That was a coincidence she didn’t want to think about.

She tried making her right hand into a fist, and it cooperated, but only weakly. “Son of a bitch,” she said under her breath.

When the road was clear, she crossed, making each step careful and deliberate; this thing with her arm spooked her, made her feel she needed to be doubly cautious not to stumble or get off balance in her low heels. She reached her car without incident and laid the plastic-draped suits across the hood, followed by her purse, which she slid off her left shoulder. With her left hand, she rummaged for the keys and found them, pressing the unlock button. Then she hoisted her purse, hoisted the suits, and tried to drape them over her right arm so that she could use her left hand to open the car door. But even that minor task was too much for the arm, which collapsed with the weight. Everything spilled onto the asphalt, landing at her feet.

“God damn it!” It was all too much, just too much at once. The stupid errand for the stupid suits—why couldn’t Brian pick up his own damn clothes? And Carson, and his pert little fiancée and their wedding plans, and the heat, and this stupid, terrifying, weak arm…She stood there in the street, facing the car door, awash with tears.

“Hey, Meg—” Carson’s voice came behind her, and, not knowing how long he’d been standing there, she quickly squatted down to pick up the mess.

“Let me help you with those,” he said, bending down. She felt his gaze on her face, knew he would ask what was wrong—which he did. And what could she tell him?

She moved aside so he could open the back door and hang the suits, letting the silence drag out, indecision gripping her. She couldn’t tell him the truth; she didn’t quite know what was true herself. How to explain the weakness in her arm and the emotions that had pushed her over the edge? What excuse would release him from his feelings of chivalrous, at best habitual, concern?

Carson prompted her. “Meg?”

“I—” she started. “Nothing. I’m okay. Just a dizzy spell—the heat, you know?” The lie sounded lame even to her.

“Dizzy? Come on; you’re
crying
.”

“Not on your account,” she said, wanting to dispell that suspicion right away.

He said, “No, of course—I didn’t think—” He stopped and took an audible breath. Then he said, “From in there, you looked like you were having trouble with your arm.”

“I was—I had a cramp. It’s happened a couple of times; I’ll be fine. It goes away.” She was in a hurry now to leave, not only to get to her appointment—which until a few moments ago she was sure would be medically pointless and instead a good excuse to see an old friend—but also because she couldn’t bear having him so close to her, acting so much like his old self that she was frightened by the comfort of his presence, the sensation of time having been erased.

Twenty-two

O
NE BENEFIT OF BEING A DOCTOR WAS THE CONNECTIONS TO OTHER DOCTORS
who would gladly work a friend or colleague into an already over-scheduled day. Brianna Davidson had no time for new patients on the kind of short notice Meg gave her, and still, she was working her in. Today’s visit was supposed to be a consultation—a chat, really, about what might be going on, and a determination about what tests, if any, might be needed.

Meg carried her X-rays from the orthopedist in an enormous manila envelope, tucked beneath her left arm as she stood at the check-in desk of Central Florida Neurological Associates.

“Dr. Meghan Powell,” she told the receptionist.

The woman found her name on the computer monitor, then looked down at a note. “One moment—let me tell her you’re here.”

The waiting room, austere but soothing in its grays and blues, held three other patients, all of whom studiously ignored one another and her. The scene differed dramatically from her clinic, where comparisons and commiserations about pregnancies and birth experiences always had to be interrupted when a patient was called. These three souls—two gray-haired women and a man of perhaps forty-five—looked as if the last thing they would do was compare notes on what had brought them in. Obstetrics was, usually, a business of hope and renewal, whereas neurology suggested lost ships chugging through dark, ice-laden seas.

“All right, Dr. Hamilton, come on back.” A nurse in deep blue scrubs held the door to the exam hallway. She waited for Meg to come through, then said, “Dr. Davidson’s just down here.”

Meg followed down the hall and into a room on the right. Brianna, a thin, dark-haired, serious-looking woman who had aced every exam the university could throw at her during their med-school days, waited behind a glossy cherrywood desk so uncrowded that it seemed the practice had opened just that morning. Meg’s own desk was a cluttered collection of folders and samples and Post-it notes, and photos of Savannah, primarily, though she also had one of Brian and Savannah together, circa 1994.

Brianna stood, reaching out to Meg with a long-fingered hand. “Meg, you’re looking terrific.”

Meg reached with her right hand and shook Brianna’s. “Thanks. You too. You wouldn’t know it, but ten minutes ago, I was ready to cut this damn arm off.”
To say the least.

“Pain?” Brianna asked as Meg sat down across from her.

“No, no pain—just the same thing I described to you over the phone: overall weakness. It comes and goes.”

They talked a little about each of their practices and their overfull lives. Brianna had nine-month-old twin boys, served on two research committees, and was leading a research trial of her own, plus her husband had just been laid off from an engineering firm and was trying to find new work. “Seeing patients here is the slow part of my day,” she said.

“I know how you feel. Thanks again for seeing me so soon; I really need to solve this mystery—I don’t have time to be laid up!”

Brianna put on frameless reading glasses. “Do you need these things yet? Every passing year I feel more and more like my mother.”

Meg felt the sting of loss. How long before the sting turned duller? How long before her first reaction was fond remembrance rather than sorrow? “No,” she said, “my vision’s still in good shape.”

“Lucky you. With all the reading we have to do…Let me have a look at the orthopedist’s report.”

Meg passed her the giant envelope. “He recommended a psychic,” she said, then waited, picking a hangnail, while Brianna read over Cameron Lowenstein’s write-up.

Brianna took the X-rays and slid them onto the light box to Meg’s right. “A psychic, huh? Funny, his report is so professional.”

“He’s eccentric. But I guess he knows his way around medicine.”

“Hmm.” Brianna studied the X-rays carefully, then switched off the light and went back to her chair. “I think a psychic might shortcut things for us, because I don’t see anything on the films.”

“No,” Meg agreed, “I didn’t either.”

“His official opinion is ‘inconclusive,’ but you said he brought up ALS.”

“Right. And so I looked over some of the literature,” Meg said, working to keep her voice steady, professional, though what she read had only confirmed what she remembered about the disease, “and until just before I came here, nothing more had happened. I was fairly convinced he was just casting in the dark.”

“ALS
is
a tough fish to hook—a lot of things look similar.”

Meg heard a pause in her voice. “So?” she said.

“So…his report notes no symptoms that
rule out
ALS…. There’s a whole lot of nothing here,” she mused. “No pain, in particular, but also you report no numbness, there’s no swelling, no spinal or joint compressions, no extreme fatigue or physical malaise. How long would you say you’ve been experiencing muscle weakness?”

“I really don’t know. I mean, I’ve felt
tired
a lot—not sleepy, you know, but like I just want to sit down and do nothing. I’m on my feet full-time, and I use my hands and arms all day long.”

Brianna nodded, empathetic.

Meg said, “If I had to make an outside guess, though? A few months. Maybe since late last fall, after my mom died and I added my father to my workload.”

“Understandable,” Brianna said. “So…why don’t you get into a gown, and then we’ll repeat the reflexes check, see if Lowenstein’s on the ball.” She sounded almost cheerful, a detective eager to track the clues. This, Meg thought, was one of the qualities that sent them down different medical paths: Brianna loved the hunt, the investigation, while she, Meg, preferred being a kind of creation assistant. An obstetrician was very often a bystander—a coach or a guide for one of the most basic of life’s processes. A big sister, passing on wisdom and supervising outcomes—like she’d done all her life.

In the exam room, Brianna put her through the same round of basic arm and leg reflex tests Lowenstein had, using a small, heavy hammer on her arms, knees, and ankles. Then she told her to clench her teeth while she pressed her fingers along Meg’s jaw and neck.

“Relax your fingers,” Brianna told her next, taking her right hand. She held Meg’s middle finger pinched between her own thumb and index finger, pressing the nail and sliding her thumb down it until her thumb clicked off the end of it. When it clicked, Meg’s other fingers flexed.

“Huh, that’s cool,” Meg said. Brianna didn’t reply but repeated the move twice more, then did it the same to Meg’s left hand. The click-flex response was less on the left.

Meg said, “I don’t remember that test.” It had been years since she’d done a reflexes exam on anyone—back in her residency, she thought.

“I’m checking for what’s called the Hoffman response. It’s basic neurological protocol, but you might not have learned it in general medicine. Honestly, I don’t remember when I learned what. Med school is all a caffeine haze in my memory, you know? Now, put your legs up here,” she directed, and Meg shifted so that she was lying on the exam table. Brianna grasped her right foot and flexed it back, holding it there. She repeated it, then did her left foot.

“Now I’m going to run a key up from your heel to the ball of the foot and across the metatarsal pad—the Babinski test.” She took the key from the pocket of her white lab coat. “Isn’t it fascinating how these things get named for whoever was bright enough to figure out the significance of the thing? Joseph Jules François Félix Babinski—his parents had trouble making choices, I guess. Now just relax your leg.” Meg lay as relaxed and still as she could, trying not to guess what Brianna was or wasn’t noticing as she stroked the sharp metal against each of the soles of her feet. Being the patient instead of the doctor was discomfiting to say the least.

“Okay, last one: just lie there and relax all your muscles.” She opened the front of Meg’s gown. “I’m going to stroke the key across your belly a few times.”

Afterward, Brianna had Meg sit up, then wrote extensive notes while Meg made herself wait without speaking. Finally, Brianna said, “Okay, why don’t you get dressed and meet me back in my office?”

“Why don’t you just say what you’re thinking right now? I know the drill about delivering bad news to the undressed patient.”

Brianna looked at her, lips compressed. “All right. This is
not
conclusive,” she said. “But okay. Yes. I see why Lowenstein was suspicious. He noted spasticity in his general exam…. And as I see it, the Hoffman response is troubling, in particular—your fingers shouldn’t flex at all. Taken by itself, I’d be concerned about a cervical lesion, but in conjunction with the clonic reflex of your left calf and low reflex response on your abdomen…”

She said some other things, but Meg was no longer focused on the words or even the tone of her old classmate’s voice. Her mind leapt ahead to what she’d read, to how no single one of those irregularities indicated ALS itself, but the combination of abdomen, foot, and hand signs and symptoms equaled what would be called a “clinically probable” diagnosis.

“…an EMG needle exam and an MRI, too,” Brianna was saying, “to rule out other possibilities. Why don’t you go straight to the lab for blood and urine tests, and I’ll have Heidi get you appointments for the others.”

“Right,” Meg said numbly.

“And even if we don’t unearth anything more optimistic, we’ll want to keep close tabs on your symptoms over the next several months before we can make a definitive diagnosis.”

Brianna’s voice was flat and factual, delivering the information like she might in a lecture or panel discussion. Meg understood; it was only the rarest of physicians who could put an arm around a patient and tell him or her, in a warm, concerned voice, that a horrible, torturous slide toward certain death was on their horizon.

“How many have you had?” Meg said, interrupting Brianna’s suggestion that she get a more expert opinion from an ALS specialist she knew in Orlando.

“How many what? ALS patients?”

“Yeah. How many have you diagnosed since you started?”

“Three, in…what? Ten years? It’s almost always something else.”

Meg nodded. “And when the patient presents with pretty definitive symptoms like mine, what, in your opinion, are the odds that it’s not—” she looked Brianna in the eye, “…that it’s
not
ALS?”

“Meg, listen, there’s always hope—”

“And there’s acupuncture and psychics and herbal remedies, and the chance that I’ll find a beatific healer wandering the streets of Ocala in a robe and sandals. Be straight with me, okay?”

Brianna looked down, as though her shoes had become suddenly fascinating. “There are several other, less serious conditions we need to consider. But if it
is
ALS…the standard prognosis is progressive debilitating physical—but not mental—decline, resulting in complete respiratory paralysis, and death,” she said. Then she looked up, eyes full of sympathy. “But I cannot stress enough that we might be looking at some other neuromuscular situation here.”

“Oh, joy.”

“Have the tests, and let me see if Andre Bolin can make time for you tomorrow.”

“Sure,” Meg said. “That’d be—gosh, that’d be great.”