Chapter 6: January 2011

Jessi pushed her blood pressure machine along the clean, wide hallway, a small blue box perched on a metal rod with a base of rolling wheels. A little basket beneath the box held the blood pressure cuffs along with an electronic thermometer. As she passed a gray-colored scuff mark on the muted yellow wall for the fourth time that night, she thought yet again that she should find something to clean it off with and chided herself for not remembering.

“One more set of vital signs, and then…” She was dressed in stiff gray scrubs, the same as every other nurses’ assistant in the hospital, and wore her bright pink stethoscope around her neck. The wide wooden door was cracked open, so Jessi pushed it open, giving a halfhearted knock as she did. The patient in the room didn’t startle, but as soon as she walked in she immediately retreated, seeing as how he was not on his bed. His massive girth was perched on a bedside commode, his gown open in the back to reveal his hairy, unkempt backside. He barely turned his head to notice her presence before saying, “Good morning miss, you can come in if you need to do something.”

“Oh no, I just need your vital signs,” said Jessi, pulling the blood pressure monitor backwards. “I’ll come back when you’re done.”

She wondered to herself if she would still hang on to a sense of privacy if their situations were ever reversed and she could not walk ten feet to relieve herself in the morning. While she spent her nights here at Franklin Square Hospital attending to the various needs of bed-bound people and probing various orifices with her thermometer, she still felt a little uncomfortable when someone perfectly capable of tying their own gown left it flapping in the breeze, or even carried on in conversation while relieving themselves.

As if to prove her point, she noticed one of the doctors dressed in a long white coat and scrubs brush past without so much as a how-do-you-do right into the room and begin the rapid-fire questions of morning rounds with the man on the bedpan before she was able to completely extricate herself from the room.

“Hello, sir, my name is Dr. Sahib. How are you today?”

“Oh, just fine, y’know, I had some back pain overnight but the nurse gave me a heating pad and it felt better. It feels like whenever I sleep in this bed–”

“–Yes, I know, the beds here are so uncomfortable,” interrupted the resident. “Are you feeling short of breath? Having any chest pain?”

“No,” replied the patient.

“No shortness of breath at all? Even when you walk?”

“Oh, well, I mean when I walk I still feel short of breath, but lying here–”

“Oh, okay, you don’t have any more orthopnea is what you’re saying.”

“Uh, yes…”

“Okay, any fevers overnight? Any chills or sweats?”


“Okay, great! Let me listen to your lungs there.”

The patient sat forward and took a few deep breaths. Jessi watched his enormous chest heave as he did so. Quickly the resident moved his stethoscope around to the front, listened to the heart sounds, then ran his hands quickly over the patient’s legs to check for swelling and pulses.

“Okay then, we’ll probably switch you to the oral antibiotics today and if you’re still feeling better tomorrow send you home. And we’ll keep giving you the Lasix.”

“Alright, doctor,” mumbled the patient as he eased himself off the commode and back into bed.

“Does he have vital signs in the computer yet?” Jessi hesitated for a second, then realized the question was directed to her and not the patient.

“Oh, no, I haven’t done ‘em yet,” she said.

“Okay, just get them in please. Thanks!” With that, he breezed by her again and was out the door just as quickly as he had come in. Jessi waited for her patient to get back into bed, then pushed her blood pressure machine back in and helped him pull his covers back up.

“How you doin’ this morning, Mr. Perkins?”

“Oh, y’know, same old same old,” replied the patient. “Everything that was soft is stiff and everything that used to be stiff is soft. And the woman at home is hot everywhere but the place you want.” He guffawed vigorously, which led into a brief paroxysm of coughing followed by the ejection of a large lump of brownish sputum into a tissue that Jessi quickly reached for as soon as she saw him starting to make noises in his throat.

“Man, you crack me up,” she said. “They takin’ care of you here?”

“Same as the last three times.”.

“You know it’s bad news when the tech get to know yo’ name,” observed Jessi. She wrapped the cuff around his arm and pushed a button, sending air into the cuff with a gentle whirring sound. It squeezed his arm tightly as she stuck the thermometer in his mouth and  then listened to his chest with a stethoscope to check his respiratory rate, then beeped as it recorded his blood pressure.

“122 over 75,” she reported. “Should I call the doctor? Or maybe call the paper! Ain’t never seen it so low.”

“I quit smoking!” he announced proudly. “But of course, now that I’m 68 and I finally get around to taking my medication every day, they say it’s too late and my kidneys failin’… it ain’t like it used to be. But I’ll bounce back. Don’t you worry.”

“I ain’t gonna worried. Too blessed to be stressed. I trust you gonna be taken care of. But I gotta get home. Been here since 11 last night, Lord have mercy.”

“Home close by?”

Jessi shook her head. “Back in the city. West side.”

“What brings you out here?”

“It’s where I could find a job.”

Mr. Perkins sighed and shook his head. “I don’t get it. Get some sleep, sister.”

“Thank you, Mr. Perkins. You do the same.”

She rolled her machine out of the room and back to the nurses’ station, where she plugged it into the wall and briefly said hello to one of her colleagues, who was coming on to replace her. She quickly typed Mr. Perkins’ heart rate, temperature, respiratory rate, and blood pressure into a nearby computer. With all of the vital signs recorded, she quickly walked to a screen on the wall where she swiped her ID badge and punched in a number to clock out. With a satisfying beep she was relieved of her duty; she waved goodbye to the nurses giving report around their station as she headed for the door.

The double doors at the entrance to the unit opened when she swiped her hand over the sensor in the adjoining hallway and she walked out to the main hallway. She took the stairs down to the first floor and walked out the front door of the hospital. She fiddled with her purse, retrieving a cigarette and her lighter from within. She remembered Mr. Perkins and his kidneys for a brief moment of indecision before lighting up.

The sun had just finished peeking over the row of trees just south of the hospital, bathing the ground with orange light and turning the temperature from the night’s frigid stillness to the day’s barely tolerable chill. She walked half a block down to the bus stop, where already a small crowd had gathered to wait for the #35 back into the city. When it arrived, she stood in line and swiped her monthly pass at the meter before taking a seat at the back, one of the last few before the rest of the passengers had to stand.

The bus lurched forward with a low rumble as its passengers packed themselves in tightly. Jessi reached into her purse and pulled out both a romance novel and Our Daily Bread, which she alternated between for a few minutes before resting her head back. She almost fell asleep before she heard her cell phone go off. Again her fingers explored her purse until she found her phone and opened her eyes to look at the text from her daughter Tanisha.

hey u home today? need 2 talk.

Jessi texted back immediately, clumsily punching the keys with her right index finger..

on the bus now but gonna be home whats up you okay ?

She waited for five anxious minutes, re-consulting the Our Daily Bread devotional she had briefly abandoned for a chapter of Black Ice, reading to herself over and over that she should cast all of her anxieties on the Lord. She was not used to getting texts from her daughter on her way home from work unless she was babysitting her two grandsons; as she turned the phone over and over in her hands she turned the possibilities over in her head. Tanisha had been going steady with that co-worker of hers– she couldn’t remember his name– for almost nine months now; maybe he had started to act like the father of Tanisha’s younger son had done before they’d split, descending into an unpredictable mess of anger and possessiveness? Jessi frequently got calls about managing the kids, especially since they both seemed to behave a little better at Grandma’s house. Questions about potty training usually waited until the afternoon, though, after Jessi got some sleep. There might be a problem with the house– last week their basement had flooded after something got stuck in the sewer line and they were still cleaning up from it.

I’m fine just need 2 ask sumthin. I’ll stop by later.

okay just let me know love you

love u 2!

Jessi put the phone away and laid her head back to offer a silent prayer for her daughter, letting her lips move without noise every time she implored on the Lord. As the bus traveled west along Route 40, it passed by countless liquor stores, fast food signs, strip malls, industrial warehouses, motels, and adult video outlets before reaching a decrepit train bridge that had “WELCOME TO BALTIMORE” painted in brightly colored faux-graffiti. A mile or so beyond, the houses began to appear more clustered together and the fast food restaurants changed from national chains to local corner stores. Jessi woke up briefly as they stopped at Johns Hopkins Hospital, its gleaming multicolored new tower still under construction. As they passed, she again wished that she could have gotten a job there instead of out in the county an hour bus ride away.

By this time of day, traffic was already starting to build up as the bus drove further into the city and they sat for ten minutes on the bridge over I-83. The highway snaked south toward the tall buildings downtown; where her gaze disinterestedly fell as she looked at the window. She mouthed another silent prayer that Gainers had managed to wake his sorry ass up and out of bed to make it to work on time, as the Lord Himself knew full well how much of a miracle it was that Gainers woke up every morning and got anywhere in a reasonable amount of time.

The bus then turned south towards downtown; after a few sluggish minutes they finally reached her transfer point, where she brushed past the rather large crowd of people standing in the aisle to exit. She only had to wait ten minutes for her next bus to arrive, where she shuffled in behind the line that had already formed and was forced to stand as they slowly worked westward. The bus slowly got less crowded as they rolled up Pennsylvania Avenue, where Jessi at last got off and walked the last two blocks home.

She noticed that Gainers had not picked up any of the mail that had fallen through the mail slot the evening before, much less opened any of it. She gently laid the pile on her coffee table in the middle of her living room and walked over to the kitchen.

In the kitchen, she poured skim milk over a bowl of plain Cheerios, pulling her phone out every now and then to look at it and make sure she hadn’t missed any more messages. Halfway through a bite, she remembered that she needed to take her pills and so she walked over to the cabinet where a row of orange bottles stood, clustered into packs like the folks waiting for the bus huddled together in the cold. Gainers had forgotten to put the lid back on his medication, which she had given up nagging him about mostly because it was a remarkably consistent way or knowing whether he had taken them. As she opened her own bottles and piled her own stack of pills, she noticed that her Lipitor and her Lexapro were down to just five pills. Payday wasn’t until next week and even though she had been given free samples to start with, now years later she was paying fifty bucks a month in copays for each one. She silently cursed those infernal drug companies as she got a butter knife from the drawer and cut one of the scored tablets in half, hoping that it might still have an effect even though it was half of what she’d been prescribed. She made herself a tall glass of water and took each pill with a long gulp of water. She then returned to her cereal, finishing the bowl with little enthusiasm and gently placing it in the sink.

She walked back out into the living room, where she turned to the pictures of her kids and grandkids on the wall, lingering for a second on each one before going upstairs. She walked up to the second floor and retrieved some laundry from out of the dryer, tossing it into a basket and carrying it up to the third floor where her bedroom was. As she carried the basket upstairs, she felt a twinge of pain in her left shoulder again. She went back down to the medicine cabinet for some Tylenol before returning upstairs and shedding her scrubs before she laid her head down on the pillow.

She slept fitfully, awakening frequently from the cold, a bad dream, or the anxiety that she might have forgotten to lock her door. Eventually she awoke at 2pm unable to sleep anymore and trudged downstairs, where she found Gainers relaxing in front of the television. His shoes were characteristically pushing dirt into her couch and he was noisily devouring a slice of pizza.

“Gainers, I ain’t gonna say nothin’ because the last thing I need today is to fight with you about some shoes, but this is ridiculous.” She lit a cigarette.

“Okay, sure,” he mumbled, clearly paying more attention to the football game on television.

She shook her head and walked back to the kitchen.

“Oh, Jessi!”

She turned back in frustration. “Now what?”

“I got some letter ‘bout my S-S-I.” He pronounced each syllable thoroughly and emphatically, as if to emphasize the importance of his Social Security Income and the grandeur of the institution. Jessi almost leapt into the living room.

“What about your SSI?”

“I dunno, can’t read all the words.”

“Give it to me,” she snapped. He offered out the piece of paper from the coffee table to her hand, which she snatched immediately and started to read.

“Oh, Gainers…” she moaned as her face fell. She took a long drag from her cigarette.

“What, what is it?” he implored.

“Oh, we should have known…”


Jessi turned towards the door..

“That either the police or Tanisha, from the sound of it,” observed Gainers.

“Either way, you best make yourself scarce. Tanisha want to have a proper conversation with grown-ups.” Jessi walked over and opened the door. Standing on the step was Tanisha, dressed in a sweater and jeans..

“Come on in, honey,” said Jessi. She turned to Gainers, who had managed to get up from the couch but was still watching the game. “Get on downstairs. You can see ‘em lose just as well down there.”

“Yes, ma’am,” he murmured before heading into the kitchen and down the stairs to his room in the basement. Tanisha sat down on the couch right where Gainers’ footprints had just been, turning her head to the game on TV for a few seconds before looking back at Jessi, who took a seat on the other couch.

“Can you put that out, Ma? You know it flares up my asthma.”

“Of course, I’m sorry,” said Jessi, burying the half-finished cigarette in an ashtray on the coffee table. “What’s going on? I’ve been so worried.”

“Oh, it ain’t nothin’ much… but you know me and Dario been together a minute.”

Jessi nodded. “I figured this might be about him. I was worried he was too good to be true. You know if you don’t feel safe, you can always stay–”

“It ain’t that, Ma,” interrupted Tanisha, shaking her head. “It’s, uh–”

“What is it?” Jessi’s curiosity and anxiety were getting the best of her manners.

Tanisha sighed as her eyes began to redden and water. “I’m pregnant.”

Jessi, even though she was sitting on the opposite couch, quickly moved forward and threw her arms around Tanisha. She felt the warm saltwater soak into her shoulder, followed by the shudder and sob of her daughter.

“Oh, oh, it’s okay, sweetie.”

Another sob, this one followed by muffled words that Jessi didn’t understand. She held her daughter for another few minutes, moving only to reach for a box of tissues next to the television. Tanisha finally sat up and took a deep breath.

“We was using a condom for the first few months… but then since neither of us was seein’ no one else, it just seemed like a hassle.”

Jessi nodded sympathetically, even though she felt her insides twist.

“And now, with the basement all a mess, we ain’t got no money for the boys have new clothes for school… Dario already be workin’ extra shifts, but they’re not enough. Just ain’t too much money when you be a rent-a-cop down at East Point Mall.”

Jessi kept her hand on Tanisha’s, who blurted out her next sentence so quickly that Jessi almost missed it.

“I need three hundred dollars for an abortion.” Her words nearly disappeared entirely into her next bout of tears. The discomfort in Jessi’s stomach grew into full-blown nausea, the back of her throat tingling with acid as she longed to just throw up.

“Tanisha…” Jessi started to speak, but couldn’t muster any words. She just kept her hand clasped to her daughter’s. The silence was only mitigated by the sound of a siren outside, following by a dog barking across the street. Jessi kept her eyes closed as she began to cry, too.

“Does he know?” she finally asked.

“No, he don’t.” Tanisha shook her head. Her thick mascara had begun to streak dark lines down her smooth, caramel-colored skin, which she fumbled at and tried to wipe away. She took Jessi’s hand with both of hers.

“You know we just… tryin’ to make it.”

“I know, I know. You just can’t go and do that… you know it ain’t right.”

“I know, Ma. But things is good with me and Dario… I don’t want to scare him away. And he hasn’t been tested for sickle cell yet.”

“He don’t know about Jenisha?”

“He know that my sister died from sickle cell… but he ain’t put two and two together about me bein’ a carrier.”

“I see,” said Jessi. “You’re gonna have to tell him one way or the other if you wanna stay with him.”

“I know, I know,” mumbled Tanisha. “I just… I wanna have his baby. Just not now.”

Jessi stood up, as if to lend more authority to her voice.

“I ain’t got no money anyway to give you,” she announced. “I’m sorry. But you know I’m here for you no matter what.”

Tanisha nodded in acknowledgement as she began to tear up again.

“You hear me? No matter what.” Her arms encircled her daughter again as she sat with her on the couch, holding her close. Another few minutes passed in silence. Jessi stroked her daughter’s hair gently, thinking of when she was 16 and had held her in this exact same place.

“Remember when you was here before?” she asked softly.

“When I was 7 months pregnant and you yelled at me ‘cause you knew my belly was big and kicked me out of the house and then came found me?”

“Yeah, then.”

“I do. That was the day you quit drinkin’.” She wiped the tears away, smearing the mascara lengthways. “One of the days you stopped.”

Jessi nodded her head silently, her face brushing Tanisha’s uniform. “Second to last, if I recall.”

“You always said it was the last.”

Jessi shuddered slightly. “Sometimes I tell the story that sounds the best out of instinct. Anyway, I been with you since then, through all the stuff you been through. And I’ll keep with you.”

“Alright, Ma. I hear you.”

Jessi got up again, this time to go to the kitchen. She returned with 4 twenty-dollar bills in her hand, which she placed in her daughter’s smooth palm and closed her fingers around. Tanisha held the money in her hand for a minute, then carefully placed it in her pocket.

“It’s all I got,” said Jessi. “You do with it what you think is right. You know what my opinion is. But I can’t have you in my living room blubberin’ up without giving you a little something.”

Tanisha finally smiled. “Okay, Ma.”

“You wanna stay and eat something? I was gonna cook some greens.”

“Naw, I gotta get to work. Thanks, though.”

“Any time. You need me to watch Jamie and Jaquan?” asked Jessi.

“No, Dario’s got them tonight. He’ll be okay. I’ll see you later. She stood and kissed her mother’s cheek, then drew in close for another tight hug. As Tanisha moved towards the door, Jessi saw her head hang silently. She opened her mouth to say something, but stopped when she knew that she had said it all already and any more of her words would only add a bigger burden. She turned away, picked up the letter from where it had fallen on the floor, crumpled it up, and threw it in the trash.




Solomon had no time to deal with the revolving door at the main entrance to University of Maryland Medical Center; thus, he veered to the right and pressed the smooth steel bar across the middle of the smaller door marked “Please Use Revolving Door.” He emerged into the carport, where people were being helped from wheelchairs into taxis or were handing their keys to the valets standing on the other side of the wide awning. He quickly removed his hospital badge and placed it in his leather bag as he reached Greene Street, with its four lanes of traffic standing still at the light whilst patients, doctors, and the occasional School of Social Work student crossed. He sped up as he saw the light facing him turn yellow, moving across the street where several garden terraces rose around an open, flat concrete space. Beneath the small park were six levels of parking garage, and as Solomon strode up towards the entrance to the garage he had to impatiently wait as nine cars emerged from the garage and turned right. Finally, the attendant standing in front of the garage ushered Solomon forward.

Half a block up, he turned right down Paca Street towards the University of Maryland Family Medicine Clinic, occupying almost the entire block with its wide tinted windows framed by dark green paneling. A stretcher was emerging from the front door, pushed by paramedics towards a waiting ambulance. The figure on the stretcher appeared to be wriggling and murmuring as he disappeared into the ambulance, which Solomon took as a reassuring sign. The ambulance sped off towards the hospital a block away.

Solomon went inside to the antechamber where the building’s security guard stood in between two stairwells leading to different parts of the clinic, where it was a little warmer. After nodding hello to the security guard that he had known by face since medical school but could not remember by name, he waited for about ten minutes. After checking his watch for the time and his phone for new e-mails once or twice, he gave up and opening a copy of the Journal of the American Medical Association and reading it in the middle of the sidewalk. He was halfway through a detailed explanation of her-2 receptor antagonism when he felt a tap on his shoulder.

“Hey there!” came a perky voice.

Solomon turned. Rita, dressed in a bright green patterned shift with long white stockings beneath her white coat, was standing there, smiling with her arms crossed. Solomon folded the magazine and put it in his bag.

“You’re late,” he observed dryly. “The movie starts in 20 minutes and it’ll take us at least half an hour to walk to Harbor East.”

“Dude came in halfway to having a heart attack.  The resident did an EKG and promptly flipped out when he saw tombstones. I was afraid I was gonna have to do two cardiac resuscitations at once. It’s good to see you, too.”

Solomon chuckled at her chiding. “Tombstones?”

“It’s what we call big anterior ST elevations on an EKG. They look like tombstones, and, well, you know when you have a big anterior ST elevation…”

“Of course,” said Solomon. “Is he okay?”

“Well, he walked into the clinic this afternoon to complain that he needed a refill on his Viagra and oh-by-the-way-my-chest-hurts-sometimes-when-I-have-sex. You just saw the ambulance take him down the street. so we’ll see.”

“Someone can walk into the clinic with an anterior MI? I thought that usually it’s a little more disabling when your coronary arteries are getting squeezed.”

“Usually it is,” explained Rita. “But you can build up sclerotic arteries slowly and have enlarged accessory vessels that still provide enough blood flow around whatever is blocking your coronary artery, in his case the LAD. In his case, he’s clearly been having ischemia whenever he exerts himself but we managed to catch it today before anything too irreparable happened. But we’ll see.”

“I guess we will. And I guess that’s a good enough reason to be late.”

“Glad that you think so,” she muttered sarcastically. “Shall we walk?” she asked.

“Let’s,” replied Solomon. They went out the door and took off east towards the Harbor, walking on the sidewalk as late-afternoon downtown traffic inched its way down Lombard in the opposite direction. The temperature was dropping quickly the sun set behind them, casting long shadows before them as they walked. Her heels clicked cheerily along the sidewalk as they strolled past a large red-brick hotel.

“I suppose I was wrong about you just seeing runny noses and back pain all day long, huh?” Solomon’s voice took on a little bit more levity than before.

“You sure were.” Rita grinned. Her eyebrows went up and down quickly, emphasizing her smugness.

“Have you ever actually had to resuscitate someone in the clinic?”

“Only once that I can remember, thank God. I mean, once a week someone finds out that they have syphilis and they immediately develop crushing chest pain and shortness of breath, thus obligating us to send them to the ER. And of course they are always fine, just a little bit of somatized anxiety. But one time there was a patient who arrested right there in the room. It was scary as hell– you know they say that in a code, the first pulse you take is your own?”

Solomon nodded.

“Well, I’m sure mine was over 200, so I didn’t bother. But I when I didn’t feel a pulse, I just called for help, laid him on the floor, started doing chest compressions. One of the residents got epinephrine and he came back after 2 rounds of CPR. EMS came, whisked him away. Then I saw a 6-year-old with a runny nose ten minutes later. 6 months later I removed a mole from the guy’s nose.” Rita’s hands danced as she told her story, recreating the actions of resuscitation and removing a skin lesion in turn.

“The guy you coded?”

“Same one.”

Solomon laughed. “You make family medicine sound so… romantic sometimes.”

Rita smiled. “I sure hope so.”

“Why’d you choose it?”

“Loved the continuity of care. The focus on community. The ability to follow patients for a long time, have them come back to me. Building those long-term relationships with whole families. It was really special and meaningful to me.”

“I get to have continuity of care, too, y’know,” said Solomon. “I get to build long-term relationships with whole families. Alcoholism runs in families, various genetic disorders run in families…”

Rita giggled. “Sure you do. But that’s not the same as doing a woman’s first pap smear, telling her when she comes in 6 months later that she’s pregnant, delivering her baby, and then seeing the baby when they’re 2 months old for her first shots. And then, when her husband gets depressed because he can’t sleep with the baby, you see him, too…”

“Well, you’ve got that one on me,” admitted Solomon. “I just never found anything particularly… exciting about primary care. Maybe if I’d had a few more anterior MIs walk into the office when I was a student, I’d change my mind.”

“You don’t think it’s exciting when someone walks in with six different problems and you know how to deal with them all in twenty minutes?”

“Honestly, not at all. I like being the expert in one thing and knowing how to deal with it in a 10-hour surgery.”

“You do like being the expert,” teased Rita.

“I came by it honestly,” he replied. They had reached the convention center, across the street from the Orioles stadium, where a crowd was disgorging from the stately brick entrance and spilling towards downtown after some offseason event. Solomon furrowed his brow as he stared past the crowd, lost in thought. In the distance, Solomon thought that he heard chanting but turned back towards Rita when a dull white train rolled through the street, dividing the orange crowd in two.

“I can see it,” he said. “Your excitement, I mean. Managing multiple complex chronic diseases might even be just as hard as resecting a cirrhotic liver.”

“Glad you’re willing to admit it,” said Rita with a smirk.

“Certainly, a better primary care system would serve us all better. Looking at how obesity, diabetes, hypertension, and substance abuse put people at risk for numerous adverse long-term outcomes, it makes sense to emphasize preventive care. Right now, though, I doubt traditional payment models or practice settings encourage this.”

“My God, who are you and what did you do with Solomon?” she exclaimed, giving him a playful push.

He laughed heartily. “What you said about six different problems just got me thinking, that’s all.”

“And you got from excitement about managing patients who have lots of problems to reforming our primary care delivery system in four minutes?”

“I can’t help but try to figure these things out.”

“I certainly sympathize.”

With that, Rita gingerly reached out her right hand and took Solomon’s elbow. He felt mildly uncomfortable at whatever feeling he had in response to her gesture, overwhelming as it was. Even though both arms were inside coats, his arm began to sweat; whichever neurons were firing in his skin seemed to have gained new powers with extra sensitivity. His first instinct was to tug his arm away, as she held loosely enough to let him do so and firm enough to make her intentions clear in her mind. Yet he took a deep breath and let her hold on as they came to a stop at a red light with a small crowd of other pedestrians. He turned to look at her face, which was expectant and radiant. Her green eyes glowed in the setting sun, her dark hair falling gently on her shoulders.

The light turned and the crowd moved. They turned from one another and set their faces east again, her hand sliding down his arm to embrace his. He was surprising to feel her squeeze just a little more with every step and even more surprised to find that he liked it. As they closer to the Inner Harbor, they heard faint chanting from a distance.

“I feel like you understand, Solomon,” she said just loud enough to be heard over the din of the crowd.


“You understand what it’s like to constantly have your work on your mind. Few people do.”

“It’s never really endeared anyone to me before,” he remarked.

“To be honest, I wasn’t all that excited about our first date. You seemed mysterious, and then it turned out you were just stubborn. But then when it ended at the hospital–”

“Rita, I–”

“Let me finish,” she insisted. “When we didn’t go dancing and instead we were taking care of someone we both have worked so hard to help– it felt very different. I realized that I wanted something else out of whatever relationship I was in, someone who could understand what it meant when your pager went off and you’re not on call.”

The chanting in the distance was growing louder, and the crowd was getting thicker instead of spreading out like Solomon expected. He was paying full attention to Rita’s words, though, and struggled to find his own. They had reached the water’s edge, where even the muddy water of the Harbor glistened in the evening sunset, broken only by the gentle shapes of boats drifting in the distance. He faced away from the water, looking directly down into her eyes.

“Rita, I’m… flattered.” He paused and withdrew his hand, folding his arms pensively. “No, I’m not.”

Her face turned from serious reflection to puzzlement.

“I mean, I know that ‘flattered’ isn’t what I’m experiencing, but it’s the closest approximation. That’s why I said it.”

“It’s okay,” she said, smiling. “You know you don’t have to say anything, right? If you’re enjoying the moment, or even if you’re not, you can sit there and enjoy it or just process what you’re feeling. You don’t have to respond right away.”

“Are you coaching me through this?” he asked, raising his eyebrows. She laughed and shook her head.

“My apologies,” she said with as much sincerity as she could muster. “I’m a family doctor who can’t help taking her work with her on a date. Surely you understand.”

Solomon shook his head along with her, laughing as he felt the tension ease just a bit. “Now you’re talking like a psychiatrist.”

“Half of primary care is behavioral health,” she opined, shrugging her shoulders and turning her palms upward.

“All the more reason why I’d be terrible at it,” he joked.

They stood still and looked at each other for a minute. Solomon tried to study her face for clues, hoping to understand what she was saying while realizing that she was likely doing the same and likely doing much better than he. He reached for her hand and clasped it tightly.

“Alright then, I’ll just enjoy this.”

“Good for you,” she said, her smile wide and bright. He found himself smiling back, grinning in a way that he wasn’t used to. He was well-used to recognizing her as an attractive woman, but now he found that he was no longer simply acknowledging that as he felt some accompanying faintly sexual urge. Even their usual smart banter seemed dull compared to this new sensation. Rather, he felt drawn to her with his body and mind, as if her diminutive frame held some unseen weight that bent the ground they stood on and pulled him in like a planet held in orbit to a star. His mind began to race with more analogies: she was like epinephrine or thyroid hormone that made every body system run faster, she was like a sprite dancing on his endorphin receptors. He wondered if he should tell her that he could only think of how she was affecting his various organ systems or save them for a more lighthearted moment. Surely she could read his face and  see here in the Harbor as the day turned to night what wonder he was experiencing.

“Shall we head to the movie?” she asked after a while.

“Why not?” he replied. “Maybe there’s a later showing.”

“Or… whatever. I only suggested a movie because it was the only other thing you said you liked to do besides work. There’s always dancing.”

“I think I’ve had enough overwhelming new experiences for the day, thanks,” he muttered demurely. Her eyebrows rose and fell quickly again.

“We could just go to dinner. There are certainly enough restaurants around, although it’s a Friday night and it might be a little wait…”

“Or we could see why people are waving signs and chanting down the street,” he said, nodding her head towards the crowd that was starting to light candles as dusk fell, some still holding up signs and others holding up their flames. City Hall lay just three blocks north of the Harbor, so clearly the crowd gathered was overflowing from the main pavilion

“Oh… it’s the rally!” she exclaimed, walking towards the candlelight. He followed behind, still holding her hand.

“What rally?”

“The rally for healthcare… some of the residents and students said that they were going. You know they’re voting on that new healthcare law in Annapolis soon.”

“Oh right, the one where we get paid less to see more people,” grumbled Solomon.

“Shush. I was just thinking about how much I liked you. You were just talking about reforming our primary care system.”

“Well then, if you really want we can go stand in the crowd and chant along with their soft-hearted, soft-headed liberal slogans. Just like Hannah.”

Rita giggled. “Hannah is a bit heavy-handed, but you have to admire her heart.”

“I admire a lot of things about Hannah. I think her heart might get her in trouble some day. Especially with her and Adam.”

“Yeah, I meant to ask you about that. Adam mentioned the other day that they’re going to Ghana together. Are they together? Is that allowed? I mean, he’s a study subject and she’s technically part of the investigating team…”

“I haven’t mentioned it to anyone,” said Solomon. “Perhaps I should have. I really don’t see any way it could affect the results. And they could both use the diversion.”

“Oh?” Rita’s eyebrows shot up.

“Well, damn, Hannah can’t stop being falling over herself to save the oppressed in whatever dark corner they hide. A little something else to occupy her time wouldn’t hurt. Maybe she wouldn’t pester me so much to donate to this thing and come advocate at that event. It’s too much already with talking at schools and then all these goddamn reporters asking me about all the shit I went through growing up.”

Rita’s face began to change as Solomon finished his thought, but it reverted so fast that he couldn’t identify what emotion she was conveying.

“She’ll find her way,” she said. “I get tired of the rhetoric sometimes myself, but she’s still learning what it means to be an advocate.”

“And Adam–  he’s 20 years old and he’s never had a girlfriend, for chrissake.”

“Solomon, you’re over 40 and you-”

“I’m different,” snapped Solomon.

This time, it was clearly disappointment across Rita’s countenance. Solomon was struck by a pang of guilt, realizing that he had probably gone too far. He was very used to this circumstance, as it normally prompted a stone-faced shutdown as he tried to stand his ground. Usually, whoever it was he had offended either backed down or backed away, and even his supervisors had gotten used to his frequent verbal indiscretions. This time, though, he felt his attempt to brush away his regret sputter as he watched Rita clearly wait for something.

“Maybe… not always different in the right way,” he said.

“You can go to the movie by yourself if you want. I know you like that sort of thing.” Her voice was icy, only accentuated by the puffs of vapor that emerged from her mouth as she spoke in the cold air.

Solomon squeezed her hand.

“I would love to go with you,” he finally stated. “To the rally, even, if that’s what you want.”


“And?” he remarked, louder than she.

She waited with her arms crossed, clearly withholding whatever she was waiting for.

“Oh. Right. I’m… sorry. For… just saying what was on my mind.”

“Is that your excuse?” she asked.

“No, I don’t want to make excuse. I fucking hate excuses. All day long. Patients, residents, insurance companies. You’ll never hear an excuse from me.”

He stared at her for a few more seconds, trying to discern from her expression what she wanted from him.

“I guess it’s going to take something else to not be like them.”

Rita nodded. “Nothing extra. Just ‘sorry,’”

“Just sorry,” he said. “Just… don’t make me do anything or say anything.”

“Of course.” she promised.

“And… make sure your ID isn’t showing or anything. I know it’ll get wrinkled, but if there are reporters around they’ll want to talk to us. Maybe I can go buy a hoodie.”

“For crying out loud, Solomon. If a reporter recognizes you, you can say that you were here tonight to learn and are still forming your own opinion about health care reform.”

“Those are both lies, but all right.”

They picked up their pace as they headed towards the crowd. Friday night was already a busy time, but the rally had injected a new energy to the area. As they moved north, they passed The Block, lit up by a jungle of neon lights advertising a seemingly endless array of carnal pleasures. A longtime Baltimore fixture, it, too, was already well-patronized on a Friday night and surely was only bothered by the lack of parking that the rally had caused.

At the pavilion in front of the large stone columns that rose before City Hall, a stage had been erected. A young man with an impressive head full of curly hair spoke emphatically into a microphone, his words carried by a grainy-sounding PA across the crowd, which as Rita and Solomon got closer they could see stretched for nearly a block in any direction. At first only the strongest syllables of the speech could be heard, but as they found a place on the sidewalk across the street from City Hall, his voice became clearer.

“…the people of Baltimore, and all of Maryland need to know that, no matter what happens, whether they require a caring word of reassurance from their family doctor or a life-saving operation from their surgeon, it will be paid for!”

A cheer rose up in response, while Rita clapped. Solomon kept his arms folded.

“Paid for by whom, I wonder?” he muttered.

“Hush,” replied Rita.

“I see so many people have come out tonight, and I thank you so much for making your voice heard. People might ask why we’re here at City Hall and not in the state capital tonight. Well, it’s because we have a city full of men and women who are too busy working two jobs trying to make ends meet to drive down to Annapolis!”

There was another cheer as the young man’s words blared across the pavilion.

“Too many people who gotta go get their blast after this,” remarked Solomon just loud enough to be heard by Rita. She looked at him crossly, but then giggled at his joke.

“People strung out on heroin need healthcare, too, you know,” she chided him gently.

“Not with my tax dollars.”

“After all, how do you think you and I get paid?”

“Like I said, our tax dollars. It just goes in a big circle. We work hard and earn the money seeing patients. The government takes forty percent. Then they give it to Medicare and Medicaid, which the people who aren’t working use to come see us and get their livers swapped out. A bunch of administrators in the middle skim off the top. One big circle.”

“Single-payer healthcare just closes the loop, then.”

“Well, good for the loop. It’s always been smarter than the doctors.”

“At least us doctors have a little more wealth at the end of the day. The people who received millions of dollars’ worth of EKGs and prescription drugs are still just as poor.”

The rally was breaking out into an energetic call-and-response of “what-do-we-want” and “when-do-we-want-it,” demanding health care for all and demanding it now. Solomon found the excitement of the crowd fascinating; he was certainly more used to the city crawling along in its ingrained habits than directing its energy towards any particular cause. The fervor whipped up by a man behind a microphone reminded him of a church service, especially with a large, mostly African-American audience calling out affirmations as they soaked up the promise of salvation. The exuberant young man– who was apparently a medical student at the University of Maryland– was replaced on the stage by a smaller, older black woman.

He protested to Rita slightly more than he actually cared about the issue because he enjoyed the banter; watching her react to his play-by-play commentary on the rally. He thought that he could see Hannah up in front near the stage, but couldn’t tell for sure. She had taped a flyer on the door of the lab last week, which he had not paid much mind to since he did not at all expect to be here. Still, being with Rita had made him more interested in the whole matter than he had expected. He continued to see how far he could go.

“More boilerplate rhetoric coming up,” he muttered.

“Well, good. Maybe if you listen closely enough to a healthy-sized dose, you’ll learn something,” she retorted.

The woman began to speak. Her voice, in contrast, was slow and measured, reaching the climax of each sentence in exactly as much time as she intended to but still with much of the same power that the earlier speaker had.

“Hello, friends and citizens. My name is Ida Carver and I am the director of the city’s outreach programs for infants and toddlers, including our initiative to deal with lead paint. I appreciated Josh sharing with us all of those facts about the many gaps in coverage right now we have among the people in Baltimore and throughout our state. Thank you, Josh. Let’s give him another hand!”

She waited a few seconds for another round of clapping.  then resumed. “I think that we have sent a clear message tonight to Maryland’s lawmakers and to people outside of the city about the need for better health coverage. But I want to close tonight by imploring you to do your part, too, and take responsibility for your health.”

She had Solomon’s attention. His eyes quickly glanced over at Rita, then darted back towards the stage when he easily detected a strong ‘I-told-you-so’ vibe coming from her.

“You see, if I’ve learned anything from my work, it’s that everything matters. The law matters because we need strong laws and building codes to make sure children aren’t exposed to lead paint while their brains are still developing. Having health insurance available to children matters so that they can get the vaccines that they need and can see a doctor when they get sick. Food stamps matter so that children can get the nutrition that they need. But a child can grow up in a smoke-free, lead-free, fully insured household and still fail. If her parents aren’t in a good relationship and her mom is depressed, we know she’s got a higher chance of having health problems as she grows up. If he’s got nowhere to safely play, we know he’s at risk for becoming a victim of violence.”

“I would like to see the studies and what quality of evidence those assertions are based on,” whispered Solomon.

“You can look them up later,” assured Rita with a pat on his arm.

“Healthcare for all is only one piece of the puzzle, my friends. If our communities are full of fragmented lives, if our families are full of violent words and torn relationships, if our hearts are full of broken promises and giving in to our worst tendencies– then I can tell you there’s nothing more that universal health coverage will do.”

There was more clapping, though not as enthusiastic as before. Solomon felt himself reaching for Rita’s hand again, as if somehow that would clarify what he was thinking about them. He watched as Ida took a candle in her hand, bent over the edge of the stage, and lit it from the flame of another in the front row.

“Thank you, good night, and God bless.”

Cheers erupted as the stage emptied, with some candles going out and others flickering on in the night as the congregation dispersed. Solomon kept holding Rita’s hand in the darkness, waiting on the edge of the sidewalk as they were passed by on all sides. Large buses that had carried people to the rally returned to take them home and the various businesses in the blocks south quickly absorbed the stream of new visitors. The chatter of the masses died down and was replaced by the usual city sounds of sirens, squealing tires, and the occasional dog barking. They took a break every now and then from studying each other’s faces to watch the stage be disassembled and the various parties who had spoken one after another earlier in the night hug one another and say goodbye.

“Well, what did you think?” asked Rita finally.

“Not as bad as I expected. I might have even learned something.”

“I knew you could do it!” She squeezed his hand tighter again. He felt his face reacting, as if there were a tendon connecting his fingers to his lips and pulling his smile wider with no control.

“So… who do I just put ‘Governor’s Office’ on my next paycheck or just start leaving $10 bills on the street corners on our way back home?” The smile narrowed to a smirk.

Rita sighed and rolled her eyes, suppressing a giggle. “Never mind.”



Chapter 7 was released on March 1, 2015.

Go to the discussion page.

Creative Commons License
Trousseau Syndrome by Matthew Loftus is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.


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