Nomi’s sick,actuallysick. Oh,fuck, is that why she’s been losing weight? My mind vomits up every bit of information I’ve ever inadvertently learned about Nomi’s health—she has a “condition,” she’s badly overdue for some kind of screening. During her physical when I touched her abdomen, she winced in pain and oh! That day early in the summer when I tried to apologize to her, I briefly glimpsed that MRI report diagnosing her with amoderate stool burden. You don’t forget those words written back-to-back about the woman of your dreams. I quickly search that phrase on the internet, but it can be indicative of many things, mostly GI-related.
My finger itches over the button for her patient records, and a wave of sick dread crashes through me.
I can’t look. IpromisedI wouldn’t look. But she’s sick, and she isn’t doing anything about it. My chest has become a tight metal locker thatmy heart is now slamming up against, over and over. I close my eyes, try to breathe.There is no emergency, everyone you love is okay. There is no emergency, everyone you love is okay.But I don’t—Ican’tbelieve it this time.
A voice clears behind me, and I swirl around in my chair, irrationally terrified it’s Nomi. My excuse is already in my mouth,I didn’t mean to look!But it’s Dr. Srinivasan standing there, his brown eyes kind. “Julian. How are you today?”
“Oh, pretty good, Dr. Appa,” I wheeze out, hand pressed hard to my sternum. “You?”
His face lights up into a smile. “You called me Dr. Appa!”
I blink rapidly. “It’s ah… growing on me.”
“Do you have a moment, Julian? I have something I want to discuss with you.”
“Sure.” I quickly minimize Nomi’s lab report and turn back to face him fully. I exhale a deep breath, trying to bring my careening anxiety back to the present moment. “More complaints?”
Dr. Appa laughs. “You know, I haven’t received a legitimate complaint about you in ages.”
“What were the illegitimate ones?”
Dr. Appa waves his hand dismissively as he takes the patient chair by the door. “Oh, Ms. Beckler thinks you should wear tighter pants.”
My eyes widen in horror. Ms. Beckler’sninety-two.
“I was very impressed with how you handled Mr. Gutierrez’s emergency, Julian.” Dr. Appa looks at me sidelong. “Many doctors would’ve increased his medications without pausing to consider why the current dosage was no longer effective. A delay in treating that underlying bacterial infection could’ve cost Mr. Gutierrez critical mobility for years to come, or even his life. But you listened. You observed. And you’d already done enough research into your patient’s condition to know what to look for. Because of that, you got him the help he needed and likely saved his life.”
“Oh.” I run my hand through my hair, surprised. “Well, I’m an ER doctor. It’s all part of it, I guess.”
Dr. Appa tilts his head. “But that’s just it—it’s not. What you did for Mr. Gutierrez was pure family medicine and really, beyond. Because of your ongoing relationship with Mr. Gutierrez, you were able to draw observations that eliminated many of the likely culprits and instead zeroed in on a rare, high-stakes complication of his disease. That’s what makes a general practitioner truly excellent—the willingness to know their patients. To stay curious and informed about their conditions. To refuse to settle when the easiest explanations don’t add up. You showed true partnership with Mr. Gutierrez that day, which is what being someone’s primary care physician is all about. I’m impressed with you and how much you’ve grown these last few months, and I’m very grateful.”
My chest aches with sudden emotion, my throat tightening. “Thank you, sir.”
“When Gisella asked if I’d take you on for your probation, I didn’t want to say yes. But she’s your biggest advocate, and I respect her judgment wholeheartedly. And Gisella was right, as usual! Now, three months later, I’m retiring and would like to give you my practice.” Dr. Appa chuckles to himself. “Funny how life works.”
I choke on my own spit. “What?”
“I’m retiring at the end of December, and I’d like you to take over my practice. Oh, don’t look so shocked! I’m sixty-eight years old. I’ve wanted to retire for ages, but I couldn’t do it without knowing my patients would be well cared for. And I believe you’re exactly the doctor to do it, Julian.”
“Me?” My breath is coming out in short little spurts. “Your practice?”
“Yes,” Dr. Appa says gamely. “On both accounts.”
Staying in Sparrow Nook, long term? The idea feels like pans clanging together in my brain. I was supposed to rise up through the ranks at Philly Gen, eventually replacing Dr. Riveras one day, or perhaps movingto an even bigger city to work at an even bigger research hospital. I’m not a primary care physician—I’m an ER doctor, and a damn good one. Despite all the stress and pressure inherent in working at Philly Gen, those halls still feel like home, offering me a life that still makes sense. After seeing Dr. Riveras this week, I’m almost certain they’ll take me back.
Could I really give up everything I’ve worked for to take this massive professional detour, landing me back where I never wanted to return? It doesn’t make sense, but Ihaveenjoyed these last few months in Sparrow Nook. Making friends, building relationships with patients like Mr. Gutierrez, spending time with Mom and Aunt Edna and the rest of the crazy D’Angelos.
AndNomi. My chest floods with giddy longing.
Would she want me to stay? Or is part of my appeal that I’m only temporary? That at the end of these six months, I’ll be headed back to Philadelphia, with a river, toll bridge, and state lines between us? Would I still be as attractive with my salary cut in half and a small cottage instead of a big studio in Rittenhouse Square? More importantly, would I be thebestfor her—the best partner, the best husband, and maybe one day, the best father to our children—if all I am is a small, family doctor?
Is that version of me enough?
Our time together feels so natural and right, almost preordained, and I’m convinced she feels it, too. But if she does, why hasn’t she confided in me about her illness yet? Doesn’t she trust me? Doesn’t she realize I’d do anything to help her?
I press a hand against my thumping chest, feeling terrified and overstimulated and absolutelydyingto talk to Nomi about it. But with the zoning hearing tomorrow, is now really the time? “This… is a lot to process.”
“It is,” he agrees. “You’ll have to decide what your priorities are. Do you want to return to your old life at Philly Gen and all the prestige itoffers? I will be happy to write you a glowing recommendation letter if that’s what you choose. But if you find that choosing long-term partnerships with your patients instead of brief, life-saving interludes fulfills you professionally, and that partnerships withotherpeople here fulfill you emotionally,” Dr. Appa says, his eyes glinting with mischief, “perhaps you’ll consider making my practice your own.” He raises both hands, palms facing me. “No rush. Take your time. Talk to Nomi. And more than anything, listen to your heart, Julian. I’m not sure you ever have.”
