by Nick Trout
“Wait a minute,” I say, “last night you told me we’re not in the animal rescue business, that we can’t afford to be.”
“We can’t. Who do you think was providing food for these dogs while they were waiting to be adopted? Let alone paying for vaccines, worm, flea, and tick treatments?”
“He did it all for free?”
Lewis nodded. “There’s not even a donation box up front. Don’t look so surprised. You’ve seen the figures for this practice. Cobb was running it into the ground through kindness.”
I’m not in the least bit surprised. Bad business labeled as one more saintly act by the pet lovers of Eden Falls sounded about right. What Lewis was misreading was my look of irritation. Yet again, Cobb would go out of his way to provide you with a good home, befriend a lost soul, so long as you had four legs.
“Take my advice,” says Lewis, “when it comes to Frieda and finding a rescue center, you’d best stay outside of a thirty-mile radius from Eden Falls.”
Good idea, everybody knows everybody in this town. “You know, I’m pretty sure the owner was lying about her urination problem.”
I catch the distressed look on Lewis’s face.
“Act fast, young man. Your good conscience will not save you from the disciplinary committee of the Vermont State Veterinary Board.”
“Uh-huh,” I manage.
“How’s the charming Ethel Silverman?” Lewis takes a sip from his cup, but it does nothing to hide his smile.
“Fabulous. Where’s your computer?”
“You’ll find what you need in that cabinet, over there.” Lewis gestures with his eyes.
I open the doors. There are three shelves on each side containing neatly organized textbooks, periodicals, and magazines. I’m paralyzed. “Bedside Manor doesn’t have a computer?”
I hear a page being turned, a pause, and then, “Nope.”
My hands are still attached to the door handles. “No Wi-Fi, no Internet, no Google, nothing.” I must remember to call Verizon and hook up some broadband for my laptop.
“What d’you mean, nothing? There are gold standard tomes in there.”
I notice a sheet of paper taped to the inside of the cabinet’s door. The blue ink of the neat copperplate may have faded over time, but I instantly recognize my mother’s handwriting and begin reading a detailed outline of her filing system, followed by a plea to keep things tidy. Visualizing this order, this discipline, I feel an instant sensation of reassurance. It’s soothing, but at the same time heavy.
I consult Mom’s guide, reach in, and remove a textbook entitled Veterinary Dermatology. “I think Mrs. Silverman pretty much hates my guts.”
“Of course she does,” Lewis says in a quieter voice. “Ethel can be a cantankerous old bird on her best days. Finds something bad to say about everyone.”
This remark stops me in my tracks. “Really,” I say, turning to face him. “Does she know who I am?”
“No idea,” says Lewis, swallowing his final mouthful of coffee. “Nice job with the beard, by the way.”
I huff, wanting to let him know that life was easier without the need for facial grooming. Shaving is supposed to turn me into someone I never wanted to be.
“Did she recognize you?” asks Lewis.
“If she did she never said.”
Lewis puts his mug down. “When were you last in Eden Falls?”
It’s a tough question, not least because it points out a brazen and damning fact—I never returned for Bobby Cobb’s funeral. “Fourteen years ago, three weeks before my mother died. But I didn’t come back to Bedside Manor. I was at the hospital in Patton the whole time.”
I can see her sitting up in bed, a red bandanna almost bright against her pale skin. She was joking, upbeat, and eager to get home. Together, we reviewed her blood work. She was in remission. She was going to be fine. This was never going to be my last visit.
Lewis fingers the handle of the mug. “And before that?”
“Not sure,” I lie, knowing exactly when it was. “It might have been the summer before my sophomore year of high school.”
Lewis does this thing with his mouth, a chipped upper incisor worrying his lower lip. I’ve noticed this when he gets serious. “Was that when you moved down south?”
“Let’s just say I was sent.”
“You make it sound like you were deported.”
I bite my tongue and choose my words carefully. “Mom never wanted me to go away. Cobb had the final word. He swore it was all about my education. Run-down regional high school versus an elite private school. Free tuition sealed the deal, thanks to my aunt Rachel.”
“Your mom’s sister, right?”
I nod. “She was the headmistress. Beaufort, South Carolina. From a purely academic standpoint it made perfect sense.” I wait a moment and add, “At least it did to Cobb.”
“So the pimply teenager never got back?”
I hesitate, the reasons beginning to stack up in the back of my throat like bile.
“Mom preferred to come down,” I say and hope I can leave it at that.
Lewis nods, and I can’t tell whether or not he knows he’s on dangerous territory.
“Okay. Then the last time you were in Eden Falls you were maybe fourteen, fifteen, and now you’re what?”
“Forty.”
“Forty. Twenty-five years later, you’ve got a different last name and you speak with a funny accent. I’d say there’s a reasonable chance Ethel Silverman has no clue that her new veterinarian is Bobby Cobb’s son.”
I think about this. I love the idea that I can maintain a sense of anonymity while I am in town, but it’ll never happen, not in Eden Falls. And there’s no way the estranged son can pretend to be keeping the Cobb legacy alive. So that means my only hope is to make money and sell the practice faster than the fierce scrutiny and the inevitable dissent.
I go back to Veterinary Dermatology and work my way down the A’s in the book’s index.
“To be fair, not every word that comes out of Ethel Silverman’s mouth is bad,” says Lewis, turning over another page. “Think about what might happen if the new doctor in this little town of ours were to solve poor Kai’s relentless skin disease when everybody else has been stumped? That’s the kind of gossip this practice could use.”
I shake my head. “Ever heard of ‘acrodermatitis enteropathica’?”
“Never,” says Lewis, “but it sounds good to me. You think that’s what Kai has?”
My finger reaches the B’s in the index. Nothing.
“Damn, I can see this photograph of a child, a baby, from an Armed Forces Institute of Pathology textbook, and he’s got exactly the same kind of crusty scabs on his face and hands as Kai. And I can even see the name of the disease—acrodermatitis enteropathica—and I’m fairly certain it’s caused by a dietary deficiency.”
“Of what?”
I grit my teeth, willing the answer to shake loose from somewhere deep inside my brain. Incredibly, nothing happens. How can that be? This new job has my synapses turned inside out. “Can’t remember.”
Lewis moves into my personal space and doesn’t give it a second thought. “How d’you do that?” he asks.
“Do what?”
“Recall that kind of obscure detail.”
“It’s what I do,” I say.
“But why study human disease?”
I’m confused. “Disease is disease, whether you’re human or a duck-billed platypus. There’s a lot of overlap. Besides, I like comparative pathology.”
Lewis flashes his bushy gray brows. “Hey, if it helps find a cure for Kai.”
“Yeah, but don’t forget what they say about hearing the sound of hoofbeats?”
Lewis nods. “A good clinician should think horses and not zebras.”
“Exactly—well, I think unicorns. Why do you think I have the term acrodermatitis enteropathica stuck in my head?”
“At least you’ve got something to go on. Of all the possible causes of sk
in disease, you’ve already narrowed it down to diet. From there, how hard can it be?”
Lewis is right. Most deficiencies are caused by a lack of vitamins or minerals. Once more I reach for Veterinary Dermatology, find V in the index, and within seconds, Vitamin A deficiency is starting to look good. Then I catch the phrase “generalized scaling.” Kai’s lesions are in very specific locations of his body. The jarring “incorrect answer” buzzer sounds in my head and I’m about to move on when a list of differential diagnoses catches my eye. I flick back to the index, to the letter Z, flick forward to the appropriate text, and discover the clinical signs of zinc-responsive dermatosis. And there it is, the canine equivalent of a disease of children called “acrodermatitis enteropathica,” a congenital zinc deficiency causing characteristic skin lesions in infants as they discontinue breast milk.
“What ever you think you’ve discovered, whatever you think the cure might be, there will always be a certain client who needs to see actions and not just hear long words. Ethel Silverman is the kind of client who needs something … how shall I best put this … tangible.”
Lewis’s rant yanks me from my page.
“Round these parts, people prefer honesty to pussyfooting and bull, if you get my meaning. Let them have it. I promise you they’ll respect you all the more.”
Newspaper abandoned, Lewis is in the process of drawing up some white fluid from a glass bottle into a needle and syringe.
“Okay,” I say, reluctantly, “so what you got there?”
Lewis grins, flicks the barrel with his finger, and recaps the needle. “Steroids. Kai will thank you for them and, if nothing else, for the next twenty-four to forty-eight hours, Ethel might even think you’re going to restore her dog’s skin to its former glory.”
He makes a show of presenting the medication with two hands, like a sommelier proffering a bottle of fine wine for approval.
“I am,” I say, accepting his injectable snake oil as I make for the examination room.
“Oh, and Cyrus,” says Lewis. “Did you meet Doris this morning?”
“Doris?”
“Our receptionist.”
Ah, the second employee on the payroll. “There was no one here.”
Lewis does not look surprised. “You’ll meet her later. She must have turned up when you were in with Mrs. Silverman.”
“Where is she now?”
“She had some errands to run. We were quiet. She’ll be back later. Oh, and she had a couple of messages for you.”
I wait a beat.
“Well, she said there were two messages on the practice answering machine.”
“She didn’t tell you what they were? She didn’t write them down before she left?”
Lewis laughs at my naïveté. “When you meet Doris, you’ll understand.”
I say nothing but think, Can’t wait.
Back in my exam room I’m greeted by, “You took your time.”
Whoa, tough customer.
“Sorry, just a few more questions, Mrs. Silverman, and I’ll have you on your way.”
Mrs. Silverman rolls her eyes, and suddenly I’m struck by her misplaced aggravation and Lewis’s words of wisdom, and it is all the encouragement I need to harden my inquiry.
“You don’t feed Kai regular dog food, do you?”
“Why?” she barks.
I will myself to keep going. “Because I’m betting you feed him something you concocted yourself, some kind of homemade diet.”
Ethel Silverman fastens her eyes on mine. “I checked with his breeder first,” she says, sounding way too uptight. “He said it would be okay, so long as I added a vitamin supplement, especially calcium for growing bones.”
I’ve never played poker. Maybe I should take it up. Inside a fist-pump is brewing because this is exactly what I am looking for. Perhaps I can do assertive after all. “So what does he eat?”
Ethel sucks on her fake teeth, as though she can almost taste the answer. “Cottage cheese and cornflakes. It was meant to be temporary. Dog’s a finicky eater.”
“Well,” I say. “I very much appreciate your honesty, ma’am, but here’s the thing. Kai’s diet is all wrong—too much calcium, too much cereal, and it’s causing a deficiency in an essential mineral—zinc.” I gesture to Kai. “That’s why your dog’s skin looks more like a crocodile than a husky.”
Mrs. Silverman pulls out a practiced sideways glance. “How do we treat it, bearing in mind he’ll turn his nose up at almost everything?”
“Simple,” I say, “stop the cottage cheese, the cornflakes, and the supplements and begin feeding Kai regular dog food.”
“You’re not listening. I told you he don’t like regular dog food.”
She eases back in her chair, letting her chin fold into the tired wattle of her neck, and smirks.
What to do? I should have a decisive comeback. Instead I’m dumbstruck. I go with a sweaty forefinger and thumb stroking my naked chin, hoping this might pass as meaningful contemplation. Veterinary Dermatology didn’t say anything about the patient with a sensitive palate and an owner with an attitude.
Eventually I ask, “You try dry or canned food?”
“Dry, of course. Canned food’s messy, bulky, and besides, it’s more expensive. You ever lived on Social Security?”
“Okay then,” I say, rushing past her, out in the waiting room (still empty), to a shelf containing a selection of canned and dry dog food on display. I grab half a dozen cans, cradle them, and offer them to Mrs. Silverman.
“Told you, can’t afford them.”
I look down at Kai and he looks up at me, tail sweeping back and forth. He’s not thinking about the food, he’s thinking about the possibility of another scratch. It’s that simple, and his need reaches out to grab me. I look back at Ethel. She’s still scowling, and I can’t help but let loose with a genuine smile as I shake my head.
“What?” she says after a beat, but her tone tells me she’s actually more curious than annoyed.
I choose my words carefully. “Mrs. Silverman, you don’t know me and I doubt you know what kind of doctor I am, but I’m hoping that you trust Doc Lewis, that you appreciate Doc Lewis must have some faith in me, and that if nothing else, I truly want to fix your dog’s horrible skin problem so that you and I will not have to see one another again for a long, long time.”
For a few seconds, the grimace distorting Ethel’s face tells me this brutally honest approach may have backfired. Time to backpedal.
“Look, I’ll pay for the food,” I say. “Let me grab you a bag.”
“Here,” says Ethel, quick to root through the pocket of her winter coat and pull out a plastic shopping bag, no doubt previously destined for a date with Kai’s poop. I deposit my cache. “Now, you’ll pay for them?” she repeats.
“This is the deal,” I say. “You try the diet, Kai likes it, his skin gets better, and you find a way to pay me back. Preferably before the end of this week. Kai won’t eat it or his skin fails to improve, we’ll say we’re even.”
To my amazement, despite my offer and my plea, the inimitable Ethel Silverman still looks unconvinced. Then I remember the steroid shot.
“And before you go, I need to give Kai a quick injection. Make him feel better.”
And like that, just as Lewis predicted, this obstinate old woman thaws enough to offer a nod of approval to my plan.
5
Like a dutiful sherpa I lug Kai’s food out to Mrs. Silverman’s salt-licked Subaru, her appreciation little more than a grunt when I wish her a good day.
“Nicely done, Cyrus,” says Lewis, taking me by the arm before I can even wipe my snowy shoes on the waiting room doormat. “Now, I have another challenge for you.”
I’m in a daze as he leads me toward the reception desk in the waiting room. It’s still unmanned. Time to look into Doris’s job description.
“I just gave away a boatload of free dog food,” I confess, embarrassed that I’m setting such a bad example. “Somehow we’
re going to have to get totally ruthless about making money.”
Lewis is busy with a pen and paper, blithe to the particulars of my transaction with Ethel Silverman, as though finagling such deals with difficult clients comes with the territory. He stops writing and looks up at me. “And how d’you propose to do that?” he says. “Drive around the streets, trying to hit passing cats and dogs?”
“No idea, but if Bedside Manor is going to be”—I think about saying sellable but settle on—“profitable … then you and I are going to have to come up with ways to make that stupid doorbell chime more frequently. By the way, you okay if we work this Saturday? Try to pick up some extra business.”
“Of course,” says Lewis, “but right now I need you to go on a house call.”
“Whoa there, I’m not ready to fly solo. At least here I’ve got you to back me up and a library of out-of-date textbooks. If my experience with Ethel Silverman is anything to go by, I’ve underestimated how different this work is from what I’m used to.”
Lewis meets my eyes. “Rubbish. It’s one more sick animal in search of a cure.”
“Yeah, but you and I are used to looking at the same disease from a completely different perspective.”
“I’m not with you,” he says.
I hesitate. What’s the best way to explain? “See, it may be the same disease, but you’re used to being at one end, and I’m used to being at the other. You’re the clinician, the hands-on guy, caught up with the client and the animal in the now. You’re trying to define the disease and stop it in its tracks. As a pathologist, if I’m involved in a case, more often than not, it’s already too late.”
Lewis frowns. “I don’t agree. Same disease, same treasure hunt. Whether you’re a pathologist looking down a microscope or a clinician listening to a chest, you’re hunting for clues that will yield the exact same prize—a diagnosis.”
“But when you’re a pathologist, time is on your side. Think about it, it’s not as though the outcome can get any worse. A corpse rarely requires a prognosis.”
