My heart squeezes at the little boy staring at me through this man’s eyes, still convinced he doesn’t deserve love until he earns it. I hate that this hearing has become another external contest he believes he must win to be worthy of acceptance. But I’m not willing to tell him the real reason I’ve been hiding from him, either. This—whatever it is between us—justbegan, and I’m not confident it could survive the truth of my disease. I’ve only just gotten Julian to accept the value cannabis has for other people’s health. How will he look at me when he learnsIneed it to cope, too? Like I’m something broken that needs to be fixed? That I’m his patient to be treated instead of a woman who wants his touch? How could a doctor who wholeheartedly believes in Western medicine understand why I’ve spent the last five years running from it? Would he really be able to hear how it’s failed me, over and over again?
Would he believe me?
Because I don’t think I could handle it if he didn’t.
The cramps seize my middle, and my eyes sting with tears. I have to go,now. “I’m sorry, Julian. I—can’t. Not tonight.”
His face crumples in disappointment as I bound out of the car and race to my front door, barely making it inside in time.
CHAPTER TWENTY-FOUR
JULIAN
By the time my last appointment of the day rolls around, I’m tired, and in the good way. At first, I resented all these small-issue appointments. Physicals, sore throats, checkups—they felt like a huge waste of my time and knowledge. But that was when I was looking at them as one-offs, thirty minutes with a person I’d never see again. That’s how it is in a big-city ER. Most patients are not repeat visitors, and while before, thirty minutes with me might mean saving someone’s life, thirty minutes here meant me getting increasingly frustrated as I try to give a highly mobile, highlyvocalthree-year-old her vaccinations.
But now, I see this position clearly. These people with their broken fingers and flu swabs aren’t one-offs—they’re long-term subjects with case histories full of questions. By the third visit with Mrs. Binardo for a recurrent UTI, we finally figured out she was suffering from kidney stones that were caused by insufficiently treated diabetes, trapping her in a vicious cycle of UTIs. When a young couple brought in their colicky six-month-old in the middle of the night for a horrifying bloody diaper, I didn’t stop researching until we worked out the culprit—cow’s milk protein intolerance passing through the mother’s breastmilk. And when Charlie received the first bottle of his Epidiolex prescription CBD oil through the special savings program I got him into, complete with a legal prescription he can take to school?
I felt like I won the Nobel Prize.
So, this morning when I saw Mr. Gutierrez booked the last appointment withmetoday, pride at how far I’ve come as a doctor surged through me. I’m grateful Mr. Gutierrez trusts me with his care, and moreover, I’m excited to be his doctor. Ever since Nomi assigned all that reading on Parkinson’s disease, I’ve continued to seek out more information about the condition. I’ve always enjoyed the study of medicine, but having a real person looking to me to help them navigate their tricky disease adds so much urgency and meaning to the endeavor.
I want to help, and I feel good knowing I can.
When Mr. Gutierrez arrives for his appointment, I knock briskly on the exam room’s door, then step inside.
“Mr. Gutierrez, good to see you,” I say, finding I truly mean it. I hold out my hand.
He looks at it, then his own where it’s pinned tense at his side, his teeth gritted. He exhales in a burst of frustration. “I’m sorry, Dr. D’Angelo. I’m having a bad movement day.”
My face softens as I take in the rigid lock of his shoulder, the contorted posture of his spine, and his shallow, rapid breathing. “When did the inability to move start?”
Mr. Gutierrez closes his eyes briefly. His brow is beaded with sweat, despite the icy air-conditioning of the clinic. “Three days ago, maybe?”
“Any other change in symptoms?” I’m already drawing up his chart in the system, scanning the vital signs taken today and comparing them against the last visit. Both heart rate and blood pressure significantly elevated. A loss of five pounds. Afever.
“I’ve had a bad stomach virus this week. It’s mostly passed.”
I bite my lower lip in. A virus could explain the change in vital signs, but Mr. Gutierrez suffers primarily from dyskinesia—erratic andinvoluntary movement. This akinesia, or inability to move, is new. “Any change in medications or strains?”
Mr. Gutierrez tries to shake his head, then curses. “Just over-the-counter medication for my stomach.”
I take the names and his guessed dosages, then run a search in the medical database for drug interactions, but nothing. On a hunch, I fill a small paper cup with water and hand it to Mr. Gutierrez’s left hand, which is still able to move, albeit roughly and with effort.
“Please, drink this.” I watch closely as he brings the cup to his mouth, then struggles to swallow the sip of water, choking and spluttering. I stand up immediately, taking the water and patting his back until the coughing subsides.
Difficulty swallowing.
“Mr. Gutierrez, I believe you’re at the beginning of an akinetic crisis, likely brought on by failure to absorb your levodopa due to the ongoing diarrhea you’re experiencing. You need to go to the hospital right now.”
“Thehospital?” Mr. Gutierrez cries. “Which hospital?”
“Your neurology team is out of Philly Gen, right?”
“Yes, but how am I supposed to get to Philadelphia?” Mr. Gutierrez tries to shake his head again and groans in frustration. “I had to call a car to get here!”
I buzz Khalil at the front desk for a wheelchair, then help him up to standing when it arrives.
“I’m taking you.” I wheel him in a quick jog toward the door. “I’m your doctor, after all.”
