CHAPTER ONE

I’m already awake, staring at flickering shadows of streetlights through oaks on my Southern Oregon bedroom wall when my bedside phone rings. My vintage clock-radio says 4:03.

The sound of the phone makes me jump, which is silly. I’ve answered thousands of night calls. I just hope there’s no problem with the four-year-old I saw about midnight with a nose full of black-eyed peas.

This will be Marlene, of course, tonight’s voice from our answering service. She has harassed me all night, very nicely I might add. She has a calming voice that even I appreciate.

I’m on my side grabbing the phone before the second ring, hoping it hasn’t awakened my daughter.

“Yes, Marlene,” I say.

“This isn’t Marlene, you idiot. Get over here. Something’s happening with Lindsey.”

“Lance?” I sit up. His voice is imprinted on my cortex, from the summer we both worked for a gyppo logging outfit right after I graduated from college. Lance is the only person I can think of outside of family who would call me directly at 4 a.m.

The reason Lance bypasses the answering service will not be obvious to you. You may assume he is a close friend. He is not. Or you may suspect he particularly values my expertise. Wrong there too. But his wife, Lindsey? That’s complicated.

Lindsey is a very long-term friend who manages the small company I helped launch. More to the point, two years ago I became her primary care physician.

Lance plows ahead. “She had one of her headaches tonight and now she’s thrashing around. Won’t stop. She’s bleeding all over the damn bed.”

“Where’s she bleeding from?”

“I think it’s her mouth.”

“How’s her color?” I pace, tethered by the cord on my bedside phone.

“Color?”

“Her skin. Is it pink or blue?”

“The light’s bad. I can’t tell.”

“Oh for God’s sake, Lance, get some light in there. But before you do another thing, pull her chin up, and get her on her side so she can breathe. Do it now.”

I hear my bedroom door open. In the faint light, I see Jennie standing in her Hello Kitty pajamas. “Dad, why are you yelling?”

I cover the phone’s mouthpiece. “Back to bed.”

She wheels around and stalks out, slamming the door so hard the windows rattle. Charming.

Lance picks up again. “She’s on her side. I can’t get her chin up. Her muscles are tight. She peed the bed. Will you get over here?”

“Color. What about her color?”

“Her face is…red.”

“Can you find her pulse?”

“Where?”

“Her neck. Below the angle of her jaw.”

“I’m trying, but she’s shaking so much I can’t feel anything.”

“How long has she been shaking?”

“Hell, I don’t know. Five minutes?”

“Hang up the phone. Dial 911 for an ambulance. Keep her on her side with her chin up until they get there. Have the ambulance take her to Saint Gemma Medical Center. I’ll meet you there.”

I wash my face and dress. Minutes later, I blow through the stop sign at Spring Street, braking hard for the sharp left, then stomp the Volvo’s accelerator and hope no one pulls out of a driveway onto the narrow predawn street.

I’ve been a physician long enough to know these after-hours emergencies always sound worse than the reality. With careful evaluation, the diagnosis will declare itself, the treatment will become obvious, and our lives will go on as before. I tell myself these things with parental sternness and take a deep breath. But my gut, which predicts future events with disturbing accuracy, ignores this self-talk. My gut tells me I’m about to have diarrhea.

I keep thinking about Lindsey’s headache. The differential diagnosis of headache-with-seizures is not a cheerful list and includes everything from brain tumor to encephalitis.

At Crater Lake Avenue, a red traffic light emerges from the dark. I slow, check for traffic, and squeak a hard right onto the avenue, then cut left across all four lanes, dodging an oncoming bread truck—its damn horn blaring—and swerve onto the ambulance ramp for Saint Gemma. As my tires chirp to a stop in physician parking, I realize I forgot to leave a note for Jennie.