Laugh (21 page)

Sam was realizing that Mike was absolutely right, but he still had to ask. “That true?”

“Why the fuck do you think I’m here folding your shorts, Sammy? Not for my health, I’ll tell you that.”

Sam prodded at the tops of his ears, hoping that the pain from the sunburn he got late this morning would wake him up enough to pay attention to what Lacey was trying to tell him.

“Stop messing.” Lacey put down the papers she was going through.

“They hurt.”

“You should have worn sunscreen.”

“I did. I just missed my ears.”

Lacey put her head down on the desk, and Sam leaned back, trying not to feel sick. Seeing his name on so many regulatory documents, realizing how much he was accountable for, looking at the huge numbers associated with this clinic, more zeros than he had seen together in his life, looking at the thick stack of employee folders—what was he doing?

What he loved best about this clinic was exam room one.

Exam room one had a door. A new door, installed with new stainless pneumatic hinges that made the door open and close without slamming.

It had waxed linoleum tiles in a golden color Lacey had called
maize
and freshly painted
ivory
walls because Sam had said he wanted white, but Lacey had said plain white was too institutional. She was right; the walls looked clean, but they glowed, and there was even a large framed photograph in here, right where a patient could see it from the perspective of the exam table.

The picture was a professional one of the little park in southside, kids grinning and hanging from the equipment, a mom—a woman he knew from high school, actually—watching them with a coffee and a smile.

Exam room one had a sink and a counter, soft gray cabinets hung and filled with supplies. The exam table was a splurge, one of the new universal access ones, wildly expensive but Sam insisted; it was comfortable and reinforced for patients of all sizes, and raised and lowered with a quiet lift to accommodate the different ways patients could move.

The chair for a family member was comfortable, he’d tried it himself. Lacey had insisted on a shelf for patients’ clothes or their purse. His rolling exam stool was snugged up next to a discreet supply cart, ready with phlebotomy and basic crash supplies.

Exam room one was
done
, set up as a prototype for the others, for inspectors and auditors; eventually it would, of course, be for patients.

It was the room he could breathe in, because this room represented the endpoint of the dream, the whole reason for the dream. Everything else was almost incomprehensible—programming, quality assurance, hiring, grant writing.

He knew what he was supposed to do in that room.

He had some dreams there, some imagination.

Yesterday he’d spent the whole morning with Lacey, and after a series of gut-churning conference calls regarding their insurance, credentialing, and licensing, they’d put together a preliminary appointment book with their newly hired staff—two RNs, four CNAs, two NPs, a family practice resident from Lakefield State University’s program, and Sam. Lacey would be the full-time administrator.

Sam was dismayed to discover he would only have patients two days a week one week, and one patient a day the alternating week, with twice monthly weekend calls.

Because, like Lacey, he was actually a full-time administrator.

They’d gone back and forth, moving hours around, but every time Lacey found more practice time for him, she’d remember how the human resources stuff would change in the winter, how she would need him for that project.

“I’m sorry I missed the interest holder’s meeting.”

“You said.”

“I am sorry.”

Lacey kept her head down, talking into the surface of their new conference table. “It’s fine. I’ve been to all the meetings. They know me. The thing is, there are plenty of people who don’t know you yet.”

“That seems bad.”

“It’s fine. It’s not like I didn’t know what this would be when I signed up for it, Sam. It’s fine.”

“What do you mean?”

Lacey sat up. “I mean that I knew that the best thing about partnering with you would be physician support. As a nurse, I’m used to it. I’ve been a clinical nurse leader at the hospital for years, I’ve saved patients from physician error multiple times, I have my own doctorate and am an advanced practice nurse and can prescribe medications, but there are some interest holders and investors and people pledging to the clinic—and even regulators and state auditors and feds—to who
none
of that would matter unless I had a doctor by my side. More than half the FQHCs like we want this to be are founded and run by nurses, but most of what I’ve learned is that there is some physician lurking somewhere.”

“You’re saying I’m a figurehead?”

“Pretty much.”

Same pushed the heels of his hands into his eyes. “Thank God.”

“Well, a figurehead who’ll get in as much trouble as I will if we fuck this up.”

“I’m sorry.”

“Just. Stop. It’s going to get worse before it gets better. As soon as we have some kind of documentable income stream and are billing we can talk about hiring an administrator to help me.”

“What’s our timeline again?”

“For full federally qualified status?”

“Yeah.”

“Five years or so? We’ll open sometime in the next three to six months as a low-income clinic …”

“Right.”

“With the help of a couple of the uncompensated service sectors from the hospital and the providers we’ll have billing here. Finish all of our sector analyses over the next two years, trying not to go under, using the start-up grants from NHS.”

“I have all that tattooed into my brain.”

“So what are you asking?”

That was the thing. He didn’t mind looking out for his people, taking care of them, but he hated all the stuff he had to keep track of and fix when he fucked things up.

The love was easy.

When his dad died after a long battle with lung cancer, Sam, for the first time ever, wanted to leave.

As soon as the last of his father’s ashes had been blown from his fingers into the snow and wind over the lake, he wanted to get in his car and drive away.

Away from decisions, big ones and little ones.

Away from bills and invoices—so many of those.

Away from how his brother and sisters looked at him, as though he was certain to let them down, but they needed him anyway.

He didn’t run away. He made decisions, good ones and bad ones. He paid as many bills as he could, robbing Peter to pay Paul, shuffling them around until everything almost worked, and then finding bills and less money.

He’d been the one to put their family home on the market to settle all the debts. He’d packed their entire family into boxes no one else wanted to go through, hauled everything to a storage locker he’d probably pay rent on forever.

He’d been the one everyone thought was heartless when he called the real estate agent, when he took the first offer that came through, thank
God
for Mike, thank Christ for him.

He did all that while Sarah recovered in the hospital after getting herself almost killed in some stupid
stunt of an illegal bike race.

Which could have been why he kept getting kicked out of her hospital room for yelling at her, even as he would walk to her unit and promise himself he would just sit with her this time. But she would look so much thinner, or she’d be maxed out on her pain meds for the day, or the surgeon’s report would suck and suddenly a nurse would have him by the elbow.

No matter how he shuffled around the problem, he couldn’t figure it out.

Sam sat up straight, trying to think, and thought about his exam room again.

The clinic backed up on a busy road that fed into the street in front of the high school, but in there it was hushed.

His life was stacks of papers he didn’t understand, heaps of laundry, file folders stuffed with bills, a family who edged around him, wary.

In the exam room, he was Dr. Burnside, and the people who sat on the exam table looked at him like he could actually do something worthwhile.

He looked at his hands, at the pink sunburn on the backs of them, at the soft and sore skin where there were blisters from picking crops and rough vines. Nina looked at him that way. Like he was worthwhile. She’d put her arm around him and hugged him in a cornfield. She’d given him work and wasn’t surprised when he did it well.

Sam closed his eyes and tried to breathe. He thought about Nina, which was normal, but this time he was thinking,
She did this.

Not this, not exactly, but she had come here with almost nothing but the brains in her head and her expertise and a broken heart and a couple of people, new-to-her people that she had to trust her gut about, and one tilled row at a time she’d built her farms, and her CSA subscriptions, and her café, and then, when she could have expanded more, she gave back to her adopted community with the urban farm plots.

He had so much more than she had started with—he had his family and Lacey, people he’d known his whole life and didn’t know not to trust. An entire community had his back. He and Lacey had sailed through a lot of the sector and community research, and had little problem signing practice agreements with low-income programs at the hospital.

He and Lacey would make it. Their success was determined by history, by the families who had watched them grow up and had invested the future in them already, long ago.

Nina grew everything herself—the farms, the business, the people, and the trust.

Just Nina.

He felt sick, all over again, that he had ended their date so catastrophically. His impulse hadn’t respected her and how strong she was when she was given the chance to learn and work toward something.

That something could have been him.

He had always wanted everything all at once, so he didn’t have to worry, so that he could have faith that nothing bad was ever going to happen.

Nina took the bad and the good things as they inevitably came, one at a time, and grew stronger and stronger, more able to bear what was difficult, and more able to accept all the good.

He could have been something good.

They could have been something good.

If it wasn’t too late, he still wanted them to be something good.

It couldn’t be a coincidence that she had opened her café in his neighborhood, and that her community farms were here, too. She lived north of here, but her condo wasn’t the home he would have anticipated.

PJ said he wanted to be like Dad, driving his limo around the neighborhood, waving at everyone, gossiping from the Burnsides’ stoop.

Sounded pretty fucking good to him.

“You see her?”

Sam looked at Lacey.

“You’re just sitting there with a dumb smile on your face and I figured you were thinking about her.”

“I was.”

“Was she there this morning?”

“No.”

“Sorry.”

“It’s okay, I’ll—”

Sam and Lacey suddenly sat straight up. Someone was pounding against the glass double doors at the front of the clinic. Sam tipped his chair over to start running toward the front.

“Nathan!” Lacey yelled in the hallway. Her son was up front hanging out with PJ and Sam felt his heart in his throat.

Nathan met Sam and Lacey in the hall. “PJ’s letting in Mrs. Washington and Rae, Mama. I think Mrs. Washington’s having trouble breathing.”

Sam felt the whole world slow down.

He turned to Lacey.

“Go get the exam room set up and start up the nebulizer with two bullets of albuterol and one of those ipratropium inhalers we got from the drug rep. I want O2, pulse ox, an intubation kit with ambu bag, steroid—IM, whatever we’ve got. Call squad.”

She was already gone.

PJ had let in Maureen Washington and her teenage grandniece, Rae. Maureen had lifelong severe asthma and Sam was surprised she could walk. Her lips were dusky, her breathing loud, too fast, and shallow.

Sam felt his blood grow warm, his heart slow down. In one beat, he was helping PJ bring Maureen to the exam room, in the next he had the nebulizer mask mixing oxygen and albuterol over her face, his stethoscope to her chest, his hand steady on her upper arm.

He nodded at Lacey to give Maureen a steroid.

He kept his eyes on Maureen’s, a woman he had seen at mass dozens of times growing up. He had gone to school with all four of her kids. Her eyes were wide and panicky, but he just kept his hand and his gaze steady, thought about the fields of her lungs that he couldn’t hear, listened to Lacey’s report of Maureen’s oxygen saturation.

“The ambulance is on its way. The medicine’s already helping. Nice and slow, Mrs. Washington.”

She nodded.

Sam listened.

He heard the soft, low whoosh of deeper breath in her lungs. Watched the muscles in her face relax. He started a slow, firm stroke from her shoulder over her large upper arm as he kept listening. He cast his eyes to the ipratropium inhaler Lacey had on the crash cart, and he coached Maureen through two puffs, returned the nebulizer mask, listened.

“We up over eighty yet, Lace?” Sam smiled at Maureen.

“Just grabbed ninety.”

“Good job, Mrs. Washington, you’re going to be okay, darlin’, you hear me?”

Maureen nodded and closed her eyes.

“We’re going to keep this going until squad gets here, don’t you worry.”

She nodded again.

“You run out of your inhalers?”

She nodded, and Sam watched her eyes fill with tears.

“You don’t worry about that, you hear me? I’m going to send Rae home with a big box of samples for both your rescue and your steroid inhalers, no matter what, okay? You come here if you start getting low again.”

Maureen pulled down her mask, whispered, “You’ve always been such a good boy, Sammy.”

Sam pulled her mask back up and tugged out one of the earpieces of his stethoscope, hearing the squad come through the front doors with PJ, Rae crying behind him, the rest of the world coming back into focus.

He looked at Lacey. She smiled.