Remedies

by Kate Ledger

  Table of Contents

  Title Page

  Copyright Page

  Dedication

  PART ONE

  PART TWO

  PART THREE

  PART FOUR

  PART FIVE

  Acknowledgements

  ABOUT THE AUTHOR

  AMY EINHORN BOOKS

  Published by G. P. Putnam’s Sons

  Publishers Since 1838

  Published by the Penguin Group

  Penguin Group (USA) Inc., 375 Hudson Street, New York, New York 10014, USA • Penguin Group

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  Penguin Books Ltd, Registered Offices: 80 Strand, London WC2R 0RL, England

  Copyright © 2009 by Kate Ledger

  All rights reserved. No part of this book may be reproduced, scanned, or distributed in any

  printed or electronic form without permission. Please do not participate in or encourage piracy of

  copyrighted materials in violation of the author’s rights. Purchase only authorized editions.

  Published simultaneously in Canada

  Library of Congress Cataloging-in-Publication Data

  Ledger, Kate.

  Remedies / Kate Ledger.

  p. cm.

  eISBN : 978-1-101-13555-6

  1. Physicians—Fiction. 2. Medicine—Research—Fiction. 3. Physicians—Family relationships—

  Fiction. I. Title.

  PS3612.E3422R

  813’.6—dc22

  This is a work of fiction. Names, characters, places, and incidents either are the product

  of the author’s imagination or are used fictitiously, and any resemblance to actual persons, living or

  dead, businesses, companies, events, or locales is entirely coincidental.

  While the author has made every effort to provide accurate telephone numbers and Internet addresses

  at the time of publication, neither the publisher nor the author assumes any responsibility for errors,

  or for changes that occur after publication. Further, the publisher does not have any control over and

  does not assume any responsibility for author or third-party websites or their content.

  http://us.penguingroup.com

  For Jonny

  Cast away our sins and transgressions and make us a new heart.

  •A KOL NIDRE MEDITATION

  Ah, love, let us be true

  To one another! for the world, which seems

  To lie before us like a land of dreams,

  So various, so beautiful, so new,

  Hath really neither joy, nor love, nor light,

  Nor certitude, nor peace, nor help for pain;

  And we are here as on a darkling plain

  Swept with confused alarms of struggle and flight,

  Where ignorant armies clash by night.

  •MATTHEW ARNOLD, “Dover Beach”

  PART ONE

  Simon Bear knew he probably shouldn’t have hired the young nurse with the bouncy ponytail, a slender woman whose clavicle bones protruded like bicycle handlebars at the base of her throat. He had no need for additional staff, and she’d only just completed her nursing degree. Emily would have said without hesitation that he was making a tactical error by extending his practice and putting another person on the payroll. A lamentable business mistake was what she would have called it. But he’d gone ahead and hired the nurse, whose name was Julie. He’d done it on impulse, and he hadn’t mentioned the decision to his wife.

  This Julie—Julie McKinley, even her name rang like the head cheer-leader from a high school squad—was due to start today. The even-toned sky suspended over Baltimore had only just begun to lighten with the dawn, and he rose with a hard-on. Emily remained on her side in a prawn like curl, twirled into private space, breathing deeply. The night mask she wore over her eyes was askew, the elastic riding up in her hair. She had plugs in her ears. He sprang from bed with purpose, brain buzzing with phrases, bits of prepared speech, things he intended to tell Julie McKinley, and he found himself jerking off in the bathroom, his mind skittering, his hand moving like a machine. The hard-on was physiological, he knew, early morning blood rush to the spongy tissue of the corpora cavernosa generated by a thalamic cascade of irrepressible hormones. He honored the physiology with cylindrical fingers and his palm. To finish, his mind reached for an image, and settled on pink, the pansy-petal bloom of an areola, Emily’s nipple crowning the small mound of her freckled breast. It was an image so old in his mind, finding it was like recovering a worn photograph, unimaginative and dull, and yet so achingly familiar, he felt almost ashamed. Beneath the areola, he imagined the flutter of her breath, intent and inviting, the first time he’d ever undressed her, unsure and eager. His hands, his mouth, moved over that new geography, breasts and hipbone, the dip of a sandbar in between. He’d fumbled, ventured here and there, tried to discern from her movements and the sound of her breathing if he was pleasing her. And he was! He’d surprised himself, Little Engine That Could! He’d brought her to consonantless moans, to cataclysmic writhing. He shuddered as he came, more from relief than pleasure, and thought, Well, that’s that. Showering and dressing with zealous speed, he found himself humming something without words, and he was eager to be downstairs, in his office, to greet his new hire.

  If Simon had asked, and he hadn’t, Emily would have provided a long list of reasons why not to hire a nurse just out of school, the investment of time, the risk of mistakes, but he’d done it. It was a gut thing. Julie McKinley had taken a tour of the practice and he’d found himself won over. She was the bright recipient of some big nursing school honor and she came with a recommendation from a dean at a university, but what interested him most was her energy and her excitement, even the way she’d inspected the exam rooms, gobbling up the details with her eyes and nodding, nodding, nodding. There was none of that sullen, hardened, know-it-all efficiency in her manner, the result of too much work experience, an attitude he’d encountered in so many nurses. As Simon would have said to Emily, work experience was something a person comes by in the process of working; it was Julie’s character he’d found hireable and a necessary change for the office, and character was something that couldn’t be trained. The moment he’d offered Julie the job, jumping up from the chair in his office, his hand shooting forward from the sleeve of his white coat, congratulatory guffaws spilling from his mouth, he’d felt like patting himself on the back.

  Anyway, negative outcomes tended not to fit into his worldview. As a matter of personal policy, he refused to sweat the small stuff. He bounded down the hallway, floorboards creaking under the lush wool knots of the Persian runners that Emily had chosen for the house, negotiating their purchase from a rug dealer in D.C. who hadn’t even wanted to sell them. He’d been certain he’d seen the dealer’s fingers tremble handing over the receipt. Emily was skilled in that way, making things happen quickly, with quiet finesse, and he felt a weird giddiness to have made a decision without even telling her.

  On his way to the stai
rs, as a matter of habit, he poked his head into Jamie’s bedroom to peek at his daughter, almost fourteen, a sleeping tangle of limbs and newly knobby joints. A silver thread of drool dangled from the corner of her mouth, pooling onto her pillow. It was the second week in July, and she was not supposed to be home, having sent herself off in a surprising burst of authoritative maturity to summer camp in Connecticut. He lingered in the doorway, just looking.

  She’d come to him in March with the camp brochure and application in hand, having procured the information from the back pages of The New York Times Magazine. “They sent this to you?” he asked, blinking at the glossy literature. “You called them?” She didn’t have many friends, and this seemed a hopeful turn for a kid who could spend weekend afternoons reading in her bedroom. But that was like her, forceful since the day she could stand on her own, able to make a plan and act on it. Her will had always been a marvel. At age five, she practically taught herself to ride a two-wheel bicycle, refusing to let him hold on to the back of the seat even as she tottered into the trunk of a tree. As he saw it, his responsibility as her father was not to question any of the decisions she made; instead, it was to enable her to make the grand gestures to shape her life. Without even reading the text, he’d nodded at the brochure description of team activities and outdoor appreciation and written the check to Camp Minnehaha.

  What came as a surprise was that she didn’t last in Connecticut more than two weeks before the camp called saying they were sorry but it wasn’t working out and they were sending her home. Crossed wires was what it was, he’d determined. Summer camps were simpleminded businesses at the core, and they didn’t really know child development. First, they’d gotten their hackles up because she’d borrowed a knife from the mess hall. Her punishment was a kind of probation, and they didn’t let her attend evening activities with all the other campers. In response, she’d managed to distress the staff by threatening to go on a hunger strike. Of course she wasn’t serious! She was thirteen, for chrissake, and it was likely she had some secret stash of food on the side and was just trying to make a public point that they’d punished her unjustly. But she scared them, all right. She skipped meals for two days straight, a protest that sent tremors of intrigue and rebellion among the other campers. Minnehaha did not have a sense of humor, it turned out. Instead of quelling what was undoubtedly an imaginary insurrection, the directors gave her the boot.

  Jamie didn’t show one ounce of regret. What she said was the brochure had turned out to be one long lie about camaraderie and outdoor skill-building. She was a kid with long, straight dark hair, broom-fringe bangs that lifted and whipped when she turned, a smart girl, but maybe a little too cynical, he thought, a little too humorless for her own good. If she could just lighten up a bit, take things a little more in stride, everything might be easier for her. Emily put up an argument that the camp owed it to Jamie to resolve the issue, if not to give her a second chance, and after all, it was the director’s word against hers regarding the knife, and it was a matter of perspective whether it was borrowed or stolen. What a waste of money, she added. But those were the practical arguments again. Always with the practicalities when so much of life demanded trusting your instincts. When he peeked in on Jamie from the doorway, he was glad she was back home. He enjoyed this part of his routine, and marveled that Jamie might not even be aware that he’d been poking his head into her bedroom just about every morning since she was a baby.

  The light outside had shifted to slate blue. In the kitchen, he grabbed an apple from a wooden bowl and began eating as he headed down the back-hall stairs to his private practice in the basement. Rotating the fruit in his hand, he gnawed at the white flesh, winnowing it down to the core as he descended in the dark. By the time he had reached the large mahogany door that separated the house from his office, he had chewed into the core itself, swallowing seeds and stem and the tiny leaves on its nether parts. He was a man who ate the entire fruit. All or nothing was what he planned to tell Julie McKinley. His philosophy. At forty-eight years of age, he was better than he’d ever been. He had energy in spades, happened to be one of those fortunate people who require little sleep, the result of good genes, probably, the dictates of a remarkable pineal gland in the brain leading a seamless biorhythm of extremes. He was also a man committed to caring. He considered himself a rare breed of doctor, refusing even to read magazine articles about crises in medicine, slashed reimbursement, all that crap. Those doctors who complained they couldn’t earn as much as they used to—crybabies, all of them. Any doctor whining about money should have chosen another livelihood. The proof of his worth was in his busy waiting room, where patients willingly endured his overbooked schedule and wheedled to be fit in between other appointments. Proof was in the flood of e-mails and pink phone messages from people wanting to get in touch with him. He’d explained part of this to Julie when she’d visited the practice, nodding agreeably. And there was so much more to tell her. He entered his office, placed himself at his desk amid piles of paper, strewn notes and half-read, earmarked medical journals. Julie McKinley was due in at seven thirty. It wasn’t quite six.

  He’d already told her the proud history of the house. In the posh Guilford neighborhood within the city limits of Baltimore, it sat on a rise of land, just half a block from the famous, tulip-studded expanse of Sherwood Gardens. Several other impressive mansions surrounded the public park, but none as eye-catching as his family’s stone mansion with its tabernacle windows—like heavy-lidded eyes rimmed with leaded glass—and the dramatic, Spanish tile-crowned turret in front. Built in 1892, the mansion was even registered on the national list of historic sites; the plaque by the front door attested to its status.

  He had taken latitude in honoring its history. He and Emily had been obligated to receive permission from the city’s historical society to build the rising curved driveway and the slate paths around the house, but he’d maintained motifs, evident in old photographs from the city’s archives, of the landscaping from the beginning of the twentieth century. He’d hired a gardener to trim the topiary bushes into conical spirals. A rambling walkway led to a Japanese footbridge and pointed the direction into a shaded plateau of flat lawn. There, with a slight intervention of modernity, a latticed gazebo that Simon had built with his own hands provided a picnic space for the family. The grounds, including the gazebo—his own design and construction, not quite finished but still undeniably functional, with a two-tiered platform, and a roof and three walls of the hexagon—had been on the city’s garden-visit tour.

  He had also told Julie McKinley that he’d been fortunate that the wing on the north side of the estate had been added in the 1940s. Seventeen years ago, in 1990, when he parted ways with Guilford Medical Associates (they’d requested his resignation—it came down to a matter of differences of personal style—but they continued to respect him, hell, they still sent patients to him), the fact of the late addition had provided a legal loophole to establish a business on the residential estate. He was able to build a three-suite medical practice on the north side of the building. Patients with appointments to see him parked along the street and, spotting the tasteful little gray-and-gold sign stuck in the ground with the emblem of a grizzly and Simon’s name and title in small capital letters, followed the slate path to the clinic entrance, which was level with the basement. His office, with his desk and his books and his diplomas, was situated at the front corner of the house, and its short windows, offering more light than view, faced to the north and the west.

  Waiting for Julie McKinley, he answered patients’ e-mails, jumping up each time he thought he heard the sound of a car. From the window, he saw Rick Grove heading down the block, briefcase in hand, pointed little head tucked down, walking toward his shiny black BMW. The Groves lived in an angular stucco house with Grecian-style bas-relief trim, a structure Simon had always—to Emily—referred to as The Sarcophagus. He called the Groves’ shiny car the Hearse. Rick, whom Simon had always considered a conver
sation hog, taught Russian literature and language at American University, and his wife, Janet, was an art museum trustee who organized charities. The two families socialized as a matter of course because Emily had long ago hit it off with Janet, though the women’s friendship remained something he’d never understood. He remembered he was supposed to call the Groves to ask if they wanted a pair of tickets to the Lyric Opera House for a weekend in September when Emily was due to speak at a conference. Lingering at the window, he watched as Rick got into The Hearse and sped off. Then he returned to his desk to answer a patient’s e-mail question about an antibiotic. When a motor idled on the street and went quiet, he jumped to his feet. He peeked through the curtains and then rushed down the hall to the waiting room, where he flung open the front door of the clinic. There she was, emerging from her car in pale purple scrubs, the color of an Easter egg, hoisting a blue backpack over one shoulder. Why get into it with Emily? One couldn’t always be expected to explain the people who were necessary to get things done. The morning was bright, dappled with affirming sunshine, and he squinted as the young woman turned toward the house.

  “You’re an early bird,” he called out, holding open the door and waving her inside.

  “Yeah, to a fault, almost,” she acknowledged, stepping past him. “I’m always afraid to be late. I wind up leaving too much time to get places.” If she was pretty, and he wasn’t sure she was, it wasn’t in a conventional way. Her face had a small, fragile look, the features within it batlike and hopeful: mascara-fringed little eyes, a slim nose, a tiny mouth. And then below her neck, those startling clavical bones.