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“I survived that. I’m stronger now. My gut flora has war medals.”

“Get the pad see ew.” He’s at the door, travel mug in hand. “Not the green curry.”

“You don’t get to dictate my order.”

“I’m not dictating. I’m informing you of the correct choice.”

“Authoritarian.”

“Efficient.”

The door closes. His footsteps go down all four flights, because the elevator has been broken since the Clinton administration and the landlord treats maintenance requests the way the Vatican treats suggestions from the laity.

The apartment is quiet. The radiator clanks. Still D minor.

I make my own coffee and drink it standing at the four feet of counter space we call a kitchen. The apartment is – and I say this with genuine devotion, because I live here willingly – a structural argument against cohabitation. Luke’s fourth-floor walk-up was fine for one emergency physician with a wardrobe that fit in a duffel bag. It is significantly less fine for two doctors with incompatible relationships to the concept of “closet space.” My garment rack takes up the bedroom wall, because Luke owns fourteen identical green scrub sets and I refuse to let my cashmere share oxygen with that level of sartorial surrender. Fourteen. I counted.

We are happy. The happiness is real – the coffee, the bickering, the way he kisses me like he’s proving a point even when the point has been made. But happy and comfortable are not the same word, and this apartment stopped being comfortable six months ago. Something has to give in. Either the apartment gets bigger or we get smaller, and neither of us is getting smaller. Luke hasn’t said anything, because Luke doesn’t say things – he endures them, quietly, the way his most stubborn ER patients endure chest pain: no complaints, nothing on the chart, until something ruptures and everyone acts surprised.

But that’s a problem for a different morning. Today I have patients.

St. Jude’s Psychiatric Unit is on the sixth floor, which the rest of the hospital treats the way most families treat the weird uncle’s bedroom – they know it exists, they’d rather not visit, and they are vaguely uncomfortable with what might be happening behind the door.

I like it up here. Down in the ER, Luke runs a room full of bleeding, screaming, time-critical bodies. Up here, the bleeding is internal, the screaming is silent, and the clock runs on a different mechanism entirely.

Denise, the charge nurse, has twenty-two years on this ward. She once told a patient threatening to barricade himself in the bathroom that he was welcome to barricade whatever the hell he liked, but lunch was at 12:00 and she was not reheating the soup.

“Morning, Dr. York. Quiet floor, mostly. But Mr. Alderman in nine is–” She pauses. “Having a day.”

“What happened?”

“Pushed his breakfast tray into the hallway at 06:15. Hasn’t spoken since. He’s moved the bed frame against the door.”

“Moved it how? He’s sixty-three with a bad hip.”

“Adrenaline is a remarkable drug, Dr. York. So is whatever his brain’s doing to him this morning.”

Derek Alderman. Room nine. Five weeks we’ve been working together. Admitted for a major depressive episode after his wife died – forty-one years of marriage, then a pulmonary embolism on a Thursday afternoon. Underneath the depression, once the fog lifted: a psychotic disorder that had probably been there for years, quiet, contained, until the grief cracked it open. Derek hears Margaret telling him to feed the dog. Biscuit – a fourteen-year-old beagle living with Derek’s daughter in New Jersey, getting fat on cheddar. Some days, Margaret is alive and the hospital is wrong. Some days, Margaret is dead and the voice is a punishment.

Today, apparently, is a barricade day.

“Security?”

“On standby. Dr. Ramanputhra said to wait for you.”

That’s the closest thing to a standing ovation I’ll get on this ward.

“Tell them to keep holding. Give me twenty minutes.”

Room nine is the corner room – a view of the river that Derek likes because Margaret loved boats. Through the reinforced window, the bed frame is jammed at an angle against the push bar. Well-constructed.

I don’t try the door. I sit down on the floor, cross-legged, back against the wall. The linoleum is freezing through my pants.

“Derek.” Conversational. The tone I’d use across a dinner table. “It’s Preston. I’m sitting on the floor outside your door, which – for context – is extremely cold, and these pants are Burberry, so this is not a casual commitment.”

A sound. Not a word. Something caught between a breath and a grunt.

“You’ve got that bed frame jammed at a solid angle. I’m going to say thirty-five degrees. Maybe thirty-eight.”