by Kate Ledger
“It would’ve been easier if he’d found something,” Maxi said, “even a bulge in the disks between the vertebrae pressing on a nerve. Then they’d have had some reason to want to operate—just do something. I wanted to know, couldn’t they just go in and cut the damaged nerves so that I wouldn’t feel pain?”
“No, no!” Simon interjected. “You don’t want to go cutting nerves. Even when surgeries are successful at first, the pain can come back. And different too: sudden, inexplicable aches, searing pain, cold, heaviness, burning, and weird unpleasant sensations that are almost impossible to describe. They spent the better part of the twentieth century slicing away nerves to treat chronic pain. They wanted the treatment to be surgical. Everybody thought if you interrupted the pain pathway, snipped the wiring, you’d stop the message from traveling to the brain. But the body stores memories of the pain—nobody knows how exactly. The truth is you can continue to feel it whether the nerve is intact or not.”
During the course of seeing doctors, she had been on antidepressants, which were commonly used to stem pain, and steroid injections to quell inflammation. She’d done physical therapy, acupuncture, acupressure, hypnosis, meditation relaxation. A chiropractor had gone through the steps of realigning her back. “My husband drove me all the way down to North Carolina, and I entered a study at a university. They gave me shots of Botox in my back, thinking that it might stop muscle spasms, if that’s what I was having.”
“I’ve never heard of that, but it’d make sense, I guess, the way that stuff works,” Simon reasoned. “Did it help?”
“Not really.”
After that, she’d driven with her husband to a big teaching hospital in New York City, where the pain doctors had recommended something called prolotherapy, injecting irritants into her back, intending to break down ligaments and tendons that would then repair themselves in a natural and fortifying healing process. Stronger connective tissue, their theory stated, meant less pain. But that hadn’t worked either. She’d stopped short of having a spinal cord stimulator implanted in her back. Simon turned to Julie. “You’ve heard of that, right? There are wires connected to a battery that sends electrical impulses to the electrodes. Electricity. The idea is that one impulse overrides another.”
“Pain’s so complex,” Julie commented. “I guess you need a lot of ways to approach it.”
“Nobody’s been able to do anything for me,” Maxi Bailey said, glancing at Julie and wiping at red-rimmed eyes. “It’s like my body’s betraying me—and everyone around me’s betraying me, too. I can tell what doctors think when they see my chart. They think I’m difficult. I’m imagining it. Or exaggerating it. And that I must be one of those people with some deep-rooted psychiatric problem who doesn’t really want to get better. They think I just want attention. You know me, I was an active person before. I liked rollerblading. We used to go, the whole family, to Lake Montibello, and do the loop around. I liked gardening, spending time with my sons. But since this happened, I spend most of my time trying to prove to people that I really feel as bad as I feel.” Her voice cracked. “I don’t want my sons to know me like this.” Her head wilted down. Simon stared at her palms turned up helplessly on her lap. “I can’t go to their swim meets, can’t meet with their teachers. I missed the school science fair this year because I couldn’t get in the car to drive. I’d like to hug them, but I don’t even really want to be touched because I don’t know what’s going to set it off. There have been times”—now she would not look up—“where the pain’s been so bad, and I’ve just felt so alone, so cut off from everybody, and such a burden that I’ve thought maybe it would be better if I were just—” A tear fell into her lap, and she looked at it a moment before her hand went to it, negating it by rubbing it into her pants. “I’ve wished I were dead.”
“It’s taken over your identity,” Simon pronounced. “It’s not just that you have the pain or that you live with it. Now the pain is you.” He looked at her, the downturned eyes, the shoulders curled like a fiddlehead fern. He had never touched a patient in a way that might be misconstrued, but he was aware suddenly of the strangest urge to take her face in his hands and press his cheek to hers. What he felt for them—all of these patients—was inexplicably like love. “Are you on meds?” he asked.
She nodded. “OxyContin. I got it from a pain clinic. But I only take it now and then. I don’t want to get hooked.”
Simon believed in opioids. He prescribed them frequently, sometimes in magnanimous doses. He hated the skepticism about addiction. He believed the studies that showed opioids were the best therapy for chronic pain. Those studies were reason enough to use them. “There’s no point in suffering,” he stated. As Maxi Bailey lifted her head and looked at him, he found himself enunciating and poking the exam table with his index finger. “Your pain isn’t helping you get better. Your body doesn’t benefit from feeling it. Nothing about it heals you. It’s the opposite, in fact, if you just ignore it—if you live just trying to get by—it can do damage. It can change the nervous system, tamper with it, screw it up. The nerves become like strings of an instrument that’s overplayed. After a while, it’s just not making music anymore. And the problem is, when this happens, nerves don’t just go back to the way they were before. They deliver amplified messages, and what you feel is heightened, a kind of distorted sensitivity. And all of this changes you, too.”
“Yeah, I feel changed,” she acknowledged.
“It’s been a long haul for you,” he said. “I can say this: I’m sure there’s a cure somewhere for you. I believe every biological process that goes awry has an antidote. It might be different for every person, or might work differently for each person at another time in their lives, but I believe we live on a planet that contains complementary compounds for the systems that exist. Somewhere in the world we have the remedies we need. We just need to find them. You haven’t tried slowly raising the dose of opioids, so why not give it a shot?”
“I don’t know,” she said hesitantly. “I don’t want to become a junkie.”
“See?” Simon said, mostly for Julie’s benefit, as he could hear himself speaking louder than was necessary. “That’s the kind of prejudice that keeps patients from healing! There’s a lot of misconceptions about narcotics. What you’re calling addiction happens in less than five percent of patients.” He stood up and lifted his prescription pad from his righthand pocket. “You need permission not to hurt anymore?” he asked her as he scribbled. “I give you permission. I’m telling you your pain is not good for your health.”
Maxi stared at the leaf of paper he held out. His words seemed to have perked her up, and she wavered as though she were trying to overcome her skepticism.
“Look, it’s a drug,” he conceded. “It’s got side effects. You might feel like your thinking’s a little fuzzy. So what? You won’t do quantum mechanics right now, but you’ll be better disposed to your body mechanics. Take back your life!”
“I don’t know.” She shook her head. “I’ll have to go to the drugstore, you know?”
“Are you embarrassed to have the prescription filled—you don’t want the drugstore guys to think you’re up to something? I’ll give you the name of a pharmacy. It’ll be in your folder—the one you take home with you. It’s a guy I know and trust in Glenburnie. He’s a little off the beaten path so you don’t have to worry about running into people you know, and he won’t give you a hard time about your medication. Only you know your pain, Maxi. You’ve got to determine what will make you better.”
Finally she reached for the prescription with trembling fingers and folded it once without reading it. When she looked to him again, there were tears standing in her eyes. They were different tears, though, and he felt billowing satisfaction as he stood, smoothed his coat and tucked the prescription pad back into his pocket. He told her he’d keep up with her to find out how the dosage was working and that she could e-mail him with any questions. “You have the right to reclaim your life,” he r
eminded her. Julie, hugging the chart to her chest, followed him to the door. “You must never give up on yourself,” he commanded.
Maxi Bailey thanked him in a voice barely more than a whisper.
By evening, he felt he had arrived at the closing scene of a play that he wished was not about to end. The sun outside was low, and the windows glowed with golden light. Like a host at the end of a dinner party, Simon personally escorted the last patient to the door. The nurses, Joyce and Melinda, each of whom had children who needed to be picked up from school or day care, had long since departed. Gabi peeled off her cardigan, preparing to head out into the humid July night. She hung it in the closet, muttering about the intensity of the air-conditioning in America, did it have to be a refrigerator indoors, after all? Rita Golodkin, who typically stayed late finishing the appointment write-ups to go in the bear-embossed folders, rapped at her computer keyboard, tuned in to Simon’s dictation on a headset. Julie stood by his side, like favored progeny, waiting for the signal that she, too, was dismissed. A perfect day, as far as he was concerned. If he’d had to explain it to Emily, he would have said, well, there weren’t even words for it.
“So whaddya think?” Simon asked Julie.
“Busy,” she said. “Everything went fast.” A piece of hair, fallen from her ponytail, curved around the edge of her small face. She looked tired, but intent not to show it.
“It’s not always this hectic,” he said apologetically.
There was a silence. Then Julie burst out, “You offered that woman such a high dose of narcotics.” Her face startled him. It was pinched in accusation, hard, with feral eyes. Her nose and chin seemed to jut forward.
“Which?”
“That woman, Mrs. Bailey.”
“Don’t tell me you’re one of those,” he sneered.
“One of what?”
“Those people who get on a high horse about narcotics. Gimme a break. The brain has its own opioid receptors. Endogenous receptors on the surface of brain cells. They found them. Right here in Baltimore, they discovered them. Little molecules attached to the cell membranes that are waiting to receive opioids, and when they do, they’re capable of making a person feel better. It’s hard to begrudge a person what their brain is wired to receive.”
“But it’s just a drug,” Julie countered. “In nursing school, we learned it’s like giving a patient a Band-Aid. It’s just covering up the pain. If she doesn’t figure out the source of the problem, she’s just going to need more drugs. And that if you help a person find other ways to handle the problem, counseling, or rehabilitation therapy—”
“She can’t do anything if she can’t get off her couch,” Simon retorted. Julie’s mouth snapped shut. He turned, heading down the hall toward his office. “My job is to treat my patients. I can’t just sit back and watch, can I?”
“Don’t you know,” Rita announced, without even pausing in her typing, “there’s a reason patients call him Dr. Feelgood. He’s their biggest supporter.”
Suddenly, he didn’t want to talk medicine or Maxi Bailey or his mission to relieve suffering. It’d been a remarkably successful day, easy, lively, smart, and he didn’t want his buzz killed with her doubts. He looked at the young nurse, the Torrence Award winner for the most promising career, when he heard the phone ringing down the hall in his office. He hurried toward it, but once he was standing at his desk, decided not to answer it. Julie had followed him as far as the doorway, and she looked like she was getting ready to leave. He remembered something that she didn’t know about him, and he believed it was a detail that explained more. “You know anything about wines?” he asked.
“Um—” she stammered. “Not really.”
“Promise not to spill the beans,” he insisted. Emily was still at work, probably wouldn’t be home for another hour, depending on traffic from Bethesda. He couldn’t remember if tonight was one of the nights she went to the gym. At the back of his office was the dark mahogany door leading into the basement of the house. He motioned for her to follow him, as he twisted a skeleton key that jutted from the door. When Julie hesitated, he added, “Not to worry. I don’t bite. I can ask Rita to come too, if you’d prefer.”
“It’s okay,” Julie said, following him into the house. She stepped onto a floor laid with ruddy Mexican tiles. The ceiling was lower than in the office, and the room had a basement’s damp coolness, lovely on the cheeks, the backs of the hands.
“This door’s part of the original house,” he pointed out. “The office, this entire side, was the addition. You can tell the construction’s slightly different.”
“It’s amazing how you can forget that there’s a whole house attached,” Julie said.
“It’s an extraordinary estate. Did I tell you it was once owned by a director of the Peabody Conservatory? In the Twenties. He and his family lived here for a bunch of years. All kinds of famous people visited him here, honored him.” Simon had never found time to dig up the archives at the conservatory, but when he and Emily had first considered buying the house, delirious about the prospect of owning such a large piece of property, the previous owners described at length the luminaries who’d crossed the doorstep at one time or another. “There were all kinds of parties,” Simon told Julie. “Happy people and lots of music. Caruso sang in front of the fireplace. One year, Rachmaninoff played an impromptu concert on the piano for the director’s birthday. It’s true. When we bought the house, the previous owners considered taking the piano with them, but I insisted it stay with the house, so we paid extra to have it.” Austere black body, gleaming curves, it sat in the large living room upstairs, though nobody played. He’d thought about taking lessons himself, but he’d never found the time. At one point, he’d even tried signing Jamie up for lessons. “Don’t even bother,” she’d stated. “I’ll never practice.”
Even Emily had agreed with him, lessons for Jamie might be a good idea. “You might find you like it,” she’d suggested to Jamie.
“Not interested,” Jamie said, and they’d all dropped the topic. But it was a magnificent instrument, wired with its strings and padded hammers as its gargantuan viscera, and somewhere in that body, the memory of the music that had been played upon it. The history of the house so enthralled him—what boisterous, glorious noise had once filled the place!—he’d always felt having the piano was like owning a piece of that time.
All along the length of the basement, large shelves broke the space like the aisles of a grocery. He glanced sideways at the meticulous storage: life’s overspill. For Emily, it was where items went that were too expensive to throw away but had proved irrelevant to daily life. For him, it was where the items waited to be put into use again. Lorraine, the housekeeper, had taken pains to keep the flotsam organized (or at least hidden away) in tidy plastic boxes. There was scuba equipment, acquired after a vacation to St. Bart’s, when they had rented and Simon had reasoned it would ultimately be cheaper if they bought what they needed. They each owned a set of golf clubs. Emily’s had been purchased used, in a pink golf bag, and she’d probably been out on a course twice during their entire marriage. Two enormous Tupperware bins contained the remains—fertilizers, pots, misters—from the days of raising orchids. There were collections: Roman coins; vintage records; old pocketwatches in velvet boxes waiting to be repaired, with tools whose tips were smaller than the end of a grain of rice. There were boxes with the yet-unused hardware and the wood pieces for the garden gazebo. Emily so disliked the abundance of abandoned material, she seldom came into the basement, and he was confident he could store his most recent purchases without her coming across them.
“Look.” Simon pointed toward the corner, where a large sheet draped over a many-haunched mass, the shape of an enormous caterpillar.
“What is it?” Julie asked.
Picking up the edge of the drape, he revealed a row of rosy wooden barrels, three of them, ringed with silver bands. Next to the barrels were several wooden crates, still unopened. On the floor stood a l
arge stainless-steel tank, shaped like a jug, that came almost as high as Julie’s waist. He had purchased three impressive-looking machines with pistons and ratchets and hinged arms.
“I ordered it all off the Internet,” he said. “It’s a kit for brewing your own wine.”
Wine-making was something altogether different from anything he’d attempted in the past. It wasn’t seasonal like his ventures into scuba or skiing, though he was still waiting for the grapes. It didn’t require a slew of unobtainable parts, like the watch repairs, or dangerous tools, like the woodworking.
“It’s not that hard to do,” Simon said. “I got books, and I bought all the best equipment available. I was a chemistry undergrad, and I’ve always been kind of a test-tube tinkerer. Making wine’s not all that different from chem lab. You can do all kinds of creative things when you’re blending flavors to make a great wine. The whole process is really only a few basic steps.”
“Hunh,” Julie responded.
“See here.” He stepped up to the stainless-steel tank. “This’s what’s known as the primary fermenter. You get your juice, you add your yeast—and there are different kinds of yeast, too. Did you know that? There’s this Champagne yeast I read about. I got some kind of French yeast. Different kinds of yeast give different yields.”
“Geez, that thing’s huge. How much are you making?”
“I’m thinking of starting with upwards of fifty gallons.”
“Of wine?” Her mouth gaped.
Simon nodded vigorously. “Sounds like a lot, I know. But the next smaller size wasn’t in stock, and I didn’t want to have to wait around. So I just bought the bigger one and I figured, why start out small and wish in two years that I had bigger, better equipment?” He stepped back and gazed at it. “It’s big, all right.”
She couldn’t be expected to understand because of her age, of course, and her background. What would she know about wine-making? It would be an impressive task, not impossible, but certainly enterprising, especially for the people he knew, like the Groves and the Ebberlys.
