Doctor Doctor

The numbers on the test are still clear in my mind.  Our daughter Madchen had gone from a 3 to a 5 on her lead count.  A score of 10 and I think most pediatricians begin to worry about their patients growing up and wearing underpants over their clothes, or getting a Ph.D. and moving their wife and child into a house with mushrooms growing in the basement and lead paint chips blossoming in every window sill.  But it wasn’t the numbers that bothered me.  They certainly didn’t make a lick of difference to Madchen who was still a couple of months away from her second birthday.

Our HMO insurance made us hustle Madchen down to Waynesburg, Pennsylvania (where I had landed my first job as an assistant professor of English) to have her blood drawn.  I had never had a “real” job before, and so when mention had been made about a health care package I’d thought that was just gravy.  The previous summer I’d been happily plunking away at my dissertation in Kalamazoo, Michigan when I was offered a one year position at a small, evangelical college just two weeks before the start of the semester.  There had been no health insurance during my many years in graduate school, HMO or otherwise.  And I was so eager to finish up my Ph.D. and see myself in the role of “professor” I probably would’ve taken the job if it meant lecturing to canaries at the bottom of coal mines, with merely a couple of aspirins and a soiled band aid once in a while to get me by.  Just so long as they addressed me as Dr. DeFrain.

But in spite of my enthusiasm for this new job, we hadn’t wanted to live in the tiny town of Waynesburg, where the college was located.  We didn’t think there would be the kinds of opportunities for Madchen we’d enjoyed in Kalamazoo.  And we didn’t think we were ready to “down-size” our own opportunities either.  So we steeled ourselves against the inconveniences, and moved into the only house we could find  (just across the border) in Morgantown, West Virginia.

One of the biggest problems with our decision was that the school’s HMO insisted we visit the doctors in Waynesburg for anything but the gravest emergency.  Another problem was the hospital itself.  The hospital in Waynesburg was in about as bad of condition as the house we’d rented.  Every time we visited there were obvious signs of patchwork repair to the lights, to the walls, and to elevators.  During one of Melinda’s check ups, we actually saw a ceiling tile come crashing, unprompted, down into the hallway.

And then, while we were waiting to be let into the lab to draw Madchen’s blood for her lead test, an obese woman came stumbling out of the door into the reception area. She was paling in a diminishing green hue.  And as she entered the hallway next to where we were sitting, she passed out with a cold thud and splat onto the linoleum.

Everyone in the waiting room, including the two of us, just stared at her legs twitching in the doorway.  The young women behind the glass partition, whose jobs it was to usher the lab patients in and out, just stared.  I think because it was a hospital we all just expected some crack squad of doctors to come rushing down the hallway and cart her away.  She moaned and I picked Madchen up and took her over to the partition.  “There’s a woman out there,” I said.

“Is she okay?” the woman, barely twenty years old I’d guess, asked.  She was trying to look around me.  But she hadn’t been alarmed enough to put down the file folders in her hand.  To that point in my life it had never occurred to me that rubber-neckers might seek out employment at a hospital.

I’m not a doctor!” I said, and Madchen asked me what the woman was doing.  “She’s resting, honey,” I said.

“She’s resting?” the young woman said with an irritating sense of relief.  I glared at her and nodded toward my daughter.  “Ohh. She’s resting…” the young woman repeated. “I better call somebody, I guess.”  Madchen and I returned to our seats.  There were people now gathering in the hall asking one another if they knew what had gone wrong with her.  Through their murmurs I could hear their worries about catching whatever it was that had dropped her into the hallway.

I told Madchen the blood test she going to get might hurt, and that if she was good she could have a sticker when it was all over.  The young woman behind the partition called out my daughter’s name, “Mad-kin? Mak-hen? Ma…”

“That’s us,” I said, and we walked away from the sight of the woman lying on the floor.  I’m not a doctor, I kept telling myself, massaging my guilt.  The nurse, an enormously overweight guy with thick eyeglasses, greasy hair, and a terrible complexion met us outside a room that looked like a converted closet.  We had to enter single file, and once we were all safely inside there was no space to even remove my coat.

I’m no skinny-mini myself, so whenever he needed to fetch something from across the “room” I had to step outside to allow him to turn around.  As I watched the waistband of his enormous underpants rise out of their crypt I felt angry.  I knew it was grossly unfair of me to hold a nurse to higher aesthetic standard than I would, say, the waitress at our favorite greasy spoon in Waynesburg.  But then again I needed some more reassurance at a dilapidated hospital than I would ordering a Double Waynesburger with cheese.

I backed out of the room once more so that he could retrieve a towellette or some soap or some other little bit of tidy cleanliness that seemed to be missing from his personal life, and then watched as he began to stab at her little arm with the needle.  It looked like someone trying to push a Bic pen into a hot dog.  She howled and cried and she looked at me for the first time as if I’d really let her down.  I knew she was only thinking of the needle, but I was wondering what I had done to bring her to this.

Earlier that semester Madchen had slipped near the top of the steep, wooden stairs at our house in Morgantown and had fallen all of the way down.  We felt she was lucky to be alive on that count, and didn’t take any more chances with her safety, no matter how cruel we had to be to do it.  The growing concern, however, was environmental.

My wife, Melinda, and I had all been sick more in one semester in Morgantown than we had been in four years in Michigan.  Madchen had one fever spike so high and so fast it threw her into febrile seizures.  When we first started coming down with colds and flus every other week our doctors kindly told us “Kids get sick. You guys are going to get sick too, so long as Madchen is in day care and around a lot of other kids. You see, little kids’ immune systems haven’t been introduced to viruses yet, and so it is all that more important to make sure they wash their hands several times each day.”  Our family physicians in Waynesburg (a cadre of  HMO doctors, PAs, RNs, and other acronyms I trust in but don’t understand) always explained everything to us as if we had no comprehension of even the simplest medical facts.  They would point to charts on the wall of the human body as if it was part of their job description to educate the local populace about where the hands were located, and how these invisible little chimeras called “germs” were able to make us sick.

“I’m working on my Doctorate,” I finally blurted out to my physician while she explained the difference between pimples and tumors to me.

“In what?” she asked, not losing a beat.

“English… Creative writing actually,” I said.  She nodded at me and continued to explain that a pimple is really just a clogged pore and that most people can avoid them by washing often and staying away from sweets.

The sad truth of the matter is, living in Morgantown in the shabby little rental we were lucky to get during an eleventh hour raid on the town (we were sure Morgantown would be better than living in Waynesburg), that I really wasworried about cleanliness.  The air of much of Appalachian mining country is polluted with coal dust.  I would mop down our front porch, trying to get rid of the black grime as well as the loose paint along the flooring, only to find it coated with grime and paint chips the following morning.

Our three dogs weren’t adjusting to their new home very well either, and when they weren’t pooping or peeing or puking their germs into the grains of the already grimy wood they were dragging in dirt from their barren little patch of yard and shedding enormous amounts of fur we contemptuously called “Chihuahuas.”  I don’t believe dogs are any dirtier than people, but I’ve come to believe that their filth can act as agar for other germs.  Some pee soaked wood can spawn influenza.  One gram of vomit in the fibers of a carpet can erupt into a steamy cloud of black lung.

And, it seems, there were molds growing in the basement that hadn’t been present during the drought months when we’d come to look at the house.  Sometimes I would go down into the basement and find mushrooms growing in the cracks of the cement floor.  These were real mushrooms, several inches tall with perfectly formed caps thriving in the midst of our home.  Apparently, this was a common enough occurrence that I saw a spray designed to get rid of “mushroom and other fungal build-up” marketed down at a local hardware store.  We changed the furnace filter, cleaned up as best we could after the dogs, and tried to leave the windows open, but we kept getting sicker and sicker.  As the bumper sticker said, “The fungus was amongus.”

Then one afternoon Madchen ate a paint chip off the floor of the front porch.  We had seen the chips lying all around, and cleaned up after them as best we could.  I kept wondering if I’d been betrayed by a foolish confidence that she was mature enough not to put things into her mouth by one and a half years old.  It was only a small chip, like the millions upon millions of small paint chips I saw every day on my drive to work.  And she ate it as if it had been calling to her for weeks, advertising its magical effects.  I immediately phoned our landlords, Ray and Darron, and asked if they knew anything about lead paint in the house.  Ray called his mother in law back in New York, who actually owned the home, and then phoned me back saying we should probably get Madchen checked for lead poisoning, but left it there.

I don’t know how I’d handle a situation like that.  We hadn’t yet sold our house in Kalamazoo, and had, in fact, rented it out to the poet Mary Ruefel who I was confident wouldn’t be putting paint chips in her mouth.  But if she had, knowing how tight our money was, how nervous we were about renting out a house we didn’t live within 500 miles of, I can’t say whether or not I expected Darron’s mother to offer to pay for the blood test.  To offer some sort of guidance or comfort I always expect from people in managerial positions, but seldom get.

Melinda suggested a lead test kit, which I found next to the fungicide at the hardware counter.  It involved, I thought, all the same processes we used in the home pregnancy kit.  Only instead of urinating onto the strip you wiped it onto the paint in question and waited for a color to emerge.  Yellow meant nothing, as with the pregnancy.  Pink meant your little girl had to go get her blood drawn.

We loaded Madchen up and wheeled her down to Waynesburg to see our pediatrician.  We had been warned away from the other practice in our HMO by our daycare owner.  Apparently, that doctor was up on charges of molestation, so when it came to choosing someone to look after our daughter’s health, it had been pretty slim pickings.  But I liked our pediatrician.  I thought he looked like Fran Tarkington with a comb over, and I marveled at his generous tan from the upright tanning booth he kept in his front office.  And though he was sometimes so amped up on caffeine (or cocaine) that his hands shook while he examined our daughter, he was still one of the few people in Waynesburg who wasn’t full of it.  In fact, the only thing bothering me about our pediatrician was that there was a red, pussy sore at the corner of his mouth which he continued to treat with some salve from a tin cup he kept tucked in his shirt’s pocket.

When he was finished checking Madchen’s eyes, ears and throat he shook his head and said, “This kind of thing’ll probably clear up on it’s own, but you’re living like pole cats in the kennel.”  His accent seemed part Texan/part Kentuckian/ part something of his own design.  He talked like he wasn’t from Waynesburg, and that gave me some contrary reason to trust him.   I didn’t always understand the specifics of his euphemisms, but I liked that he made the effort to be homey and (you could argue) poetic.  He wrote up an order for the lead test over at the hospital and told us we’d better think about moving out of our house.  “And don’t you let ‘em jump her bones down at that hospital, all right?”

We hadn’t been in the house for two full months yet and already we were thinking about breaking our lease.  The problem, from where I stood, was that we’d be out all that money.  We couldn’t possibly afford to rent another place, or likely even find one in Morgantown.  Melinda’s logic was more direct.  Which was more essential, our health or our money?

Against any prevailing logic we continued to stay in the house — in part because we couldn’t stand the strain of another move, and in part because there was no better place to be had in Morgantown.  And so a few weeks after the paint chip and the blood test, Madchen came down with a rash on the inside of her mouth.

I thought it was just thrush, at first.  “Kids get sick.”  There were yeasty lesions on the sides of her mouth and on her tongue.  My doctoring consisted of pushing Madchen to drink several pints of cranberry juice.  She quit eating and she cried when she drank anything.  I called our pediatrician and he told us to bring her down.  He sounded shaky on the phone, and I took that to mean he was deeply concerned.

When we arrived at his office we were ushered right into one of the examination rooms.  I noticed the paneling on the walls was bubbling, and the old carpeting looked threadbare and dirty, and it was finally starting to bother me.  I gave Madchen a model of the human ear to play with, but she preferred to tear the paper sheet off of the examination table.  Melinda and I watched the clock, fiddled with the plastic ear, and talked in whispered tones about what vile disease Madchen might have been stricken with.  Could it have something to do with the lead paint?  Did she eat one of the mushrooms in our house?

I tried to change the subject to my work.  I had been to chapel that day.  It was something the dean and the president stressed as an important demonstration of the faculty’s commitment to the foundations of a Christian college.  But there hadn’t been any students there that day to impress.  Aside from the students in the choir, the mass has been made up mostly of other one year appointees and non-tenured faculty.  One of the vice presidents, who fancied himself an orator from the Teddy Roosevelt school, had driven a metaphor linking up cars and Christ straight into the ground.

“Well,” our pediatrician said as he came busily into the room.  He was wearing a very large belt buckle, like a rodeo champion, and a tight and worn Scooby-Doo t-shirt tucked in behind it.  “Let’s take a look at your pee-pee.”

“Pee-pee” is a term for the genitals I’ve never gotten comfortable with.  I don’t like it when little kids say it, I don’t like it when my wife teases me about my irrational fear of the term, and I especially don’t like it when my doctor says it.

I helped strip Madchen down while Doctor Pee-pee began poking around in her vagina with his bare fingers.  His hands were visibly shaking and he seemed to need to give himself instructions just to keep to the task at hand.  I wanted to ask him to put on some gloves, or wash his hands, but I was still getting over his informal description of my daughter’s private parts.  He then picked up a tongue depressor and tried to look into her mouth while he muttered to himself about Latinate terms for sores and pustules.  Though I knew he did this only to impress us, this, at last, was the exact kind of thing I wanted to hear.

“Hold on,” he said, suddenly, and he left the room.  He came back in with a large book of photos of sores and wounds and began maniacally flipping through the pages.  I tried to read over his shoulder, but he was moving the pages so quickly it began to look like one of the movies from my high school shop class: This is what happened to Kenny when the printing press grabbed a hold of his long hair.  Those films were always ripe with blame and aspersions.

He plopped the book down on the naked table and looked at Melinda and me.  “Are you church going people?”

I was stunned.  The thing I had really liked about Doctor Pee-pee was that he didn’t seem under the perverse sway of the rabid evangelicals who ran the college and the local government.  “We go sometimes,” I responded meekly.  That question always brings on irrational genuflection from me.

“You’d better start going,” he said.  And he left us alone.

Melinda and I stared at the empty door frame where Doctor Pee-pee had just disappeared himself.  We reverted back to our hushed tones, as if my admission that we didn’t regularly attend church might further damn our baby daughter, and further sin might do her more harm.  “Is he serious?” we said to each other.  I picked up the picture book and let it fall open again, hoping to find what hellish picture had sent him running from the room.  They were all hellish.

“Cancer?” Melinda finally said.

“My God,” I said. “It can’t be.” Though I knew I was lying to both of us.  I kept thinking about the lead paint.  About the quality of air.  About bringing my wife and daughter to live in this place.

Doctor Pee-pee returned with another book, and now looked at us as if he expected us to provide some answers.  He began to pick at his teeth with his bare fingers.  Fingers I know he hadn’t washed during his comings and goings.  “You work at the college?” he said to me.

“Yes, while I’m finishing up my PhD in creative writing,” I said.

“You can get a PhD in that?” he said.  “Hmm … well, it looks like your little girl here has a form of herpes. It’s a virus, which is a little critter that gets into your cells and breeds like the dickens.”  He went on to explain rudimentary biological science to us, but we were both too stunned with this new disclosure to do anything but listen with rapture.  As if he were revealing the secrets of the universe in his down-home slang.  His diagnosis, thankfully, eventually proved wrong, but we wouldn’t know that until more than a year later.  In the meantime we listened intently to everything he had to tell us about the horrors of herpes.

When he stopped to pick at his teeth with renewed vigor I asked the difficult question: “How does a one year old get herpes?”

“It just happens,” he said, finally finding a piece of his lunch between his incisor and whatever tooth is next to the incisor. “She could’ve gotten it anywhere. I’ve got it myself.”  And then I recalled the cold sore at the corner of his mouth the last time we had seen him.

So I asked. “It’s contagious,” I said. “Isn’t it?”

“Herpes? No, no… It might flare up from time to time, but it’s not contagious.”  And that’s about the time I tuned out.  His eyes were wild, and his hands kept trying to crawl away from his body while he talked about how long Madchen would have the sores, and how difficult it was going to be for everyone.

When he paused to fidget with the book on the table I repeated my question.  “But it’s contagious, isn’t it?”

“Nope. No way,” he said.  And he wrote us out another prescription.  “Doctor of creative writing, huh?”  He said this as if he were considering a new direction.



The stress of the house and my new job were starting to wear on us.  I was teaching texts in classes I often didn’t have time to read, let alone prepare for.  One of the problems with taking the job last minute was that I had to teach the works the previous professor had ordered for the class, and so I was deep into The Grapes of Wrath, having never read the work myself.  The clincher was that I’d spend all my time at home reading these works and trying to prepare a lesson plan just to show up and realize not a single student read more than fifty pages.  They never did, even the best students knew that the school was afraid to fail anyone for fear of losing their tuition money, and so the onus was on the professors to take the students by the hand and teach them works they were unwilling, and sometimes unable, to read.  Some of my students never bothered to buy the books for the class, opting instead to show up with the Cliff notes version of the text splayed out on their desk.

We often sought solace in Pittsburgh on the weekends.  And did things like go to the museum at Carnegie Mellon and then drive around the downtown for hours admiring all of the shops and the cafes we were too tired and too poor to go into.  On the way back from one of these trips Melinda spotted a Cracker Barrel restaurant that had just opened in south Pittsburgh and demanded that we stop to sample their fare.

Now I wouldn’t exactly be telling secrets on Melinda to say that she has a jones for restaurants.  And sometimes this manifests itself in the need for a quick fix.  A fast food joint.  But I was surprised at how adamant she was that we stop at this particular eatery.

I’ve always been afraid of places that offer “down home” cooking, but apparently I was the odd man out here since there was a forty-five minute wait for a table.  I already felt claustrophobic and I’d made the tragic mistake of trying to wait it out in front of the Beanie Baby display where the hungry hoards seemed to gravitate as if called by God.  On top of this, it was clear to me that the place was being run by punkish high school kids who could really give a hoot if the buffet crowd got their food in a timely manner.

When we finally got to our table Melinda was in hypoglycemic rage and Madchen was only content when she was throwing the wooden triangle portion of the golf-tee game at fellow patrons.  Our silver ware looked like it had just been used on someone else’s spaghetti.  Madchen launched into such hysterics when I took her knife and fork away that the help were clearly steering clear of our table.  I quit apologizing long before my chicken fried chicken and mashed potato mash showed up.

I think we all must have fallen into deep slumber the second we returned home because when Melinda’s vomiting woke me at three a.m. I was still wearing my jeans and button-down shirt.  “What’s wrong?” I asked.

“I think I need to go to the emergency room,” she said from the bathroom, and then heaved into the toilet.

“No you don’t,” I said.  And then I went back to sleep.

I woke again when Melinda jabbed me in the stomach.  “I’m going to the emergency room,” she said. “I can’t stop throwing up. You need to get Madchen dressed.”  And with that she walked down stairs, out the kitchen door, through the gate and into the garage.

I tried to wake Madchen up so I could change her out of pajamas.  I’m not sure what it is that made us think we had to have our 1 year old daughter gussied up to go to the emergency room at three thirty in the morning, but there it was.  She fought waking, and lay in my arms like a pile of kindling.  When she finally fired up she vomited all over me, herself and the floor.  The dogs, who had started barking since Melinda left the house some twenty minutes before, stopped long enough to try to eat the barf off the floor.  “Get out!” I yelled, and I kicked them all soundly in the butts as I opened the kitchen door to let them out in the yard.

I finished changing Madchen, who mercifully fell back into a sleep, and stepped out the door to leave.  That’s when I noticed the gate.  Melinda had left the gate open when she walked out to the car and the dogs were gone.

I ran Madchen over to the car and strapped her into her seat.  “The damned dogs got out!” I said.  It was pitch black in the mountains, and there was no moon out.  Only a thin fog between the trees catching some luminescence from the stars and what few lights were on at that hour.  “Ruge! Bella! PEEKER!”

Melinda pulled herself out of her seat and began calling feebly, “Ruge…Bella…(wretch)…Peeker…”

We found Bella in the front yard.  She’s fat and determined, but seldom gets very far.  Ruge came loping down the street when Melinda called to him a few minutes later.  There was only Peeker left to find.

I could hear a dog fight in the distance and told Melinda to keep calling.  I was going to follow the sounds of the fight.  The street I ran down was overgrown with ivy and shrubs and I stumbled the entire way in the dark.  I could hear the dog fight getting closer and closer and I knew I had to be close, but I couldn’t see anything.

Suddenly I slipped and I could feel myself tumbling through weeds and branches, head over heels I was sliding through mud and leaves until I stopped at the bottom of someone’s yard.  I could smell the dog shit and knew I had rolled through piles of it on my way down, but right in front of me was a small dog house with a Jack Russell terrier, its lip curled in fear, guarding the front door.  A few feet in front of the Jack was Peeker, bloodied by the much smaller dog, her eyes glowed in the dark night.  I tackled her and held her by the throat as I made my way back up the hill.  Her blood and foam were on my face and on my chest where I had torn my shirt in my fall.  “God-damn you, Peeker,” I said.  I wanted to choke her right then and there and be done with that much of our misery.  There was nothing left of my patience.

When we got back to the house I could hear Madchen crying from the van and Melinda asking, softly, if I’d found Peeker.  I threw the dog meanly onto the porch and she limped into the house.  She had clearly gotten the worst of it from the little Jack chained to his house at the bottom of the hill.

When we walked into the emergency room the nurse asked if I needed to be seen immediately, or if I could wait until we filled out the paperwork.   “It’s not me,” I said, suddenly aware of the awful smell coming from my clothes and the blood drying on my face, chest and hands.  “It’s my wife. She can’t stop throwing up.”  I’m sure the nurse thought she had a good idea why.

We were familiar with the West Virginia University emergency room by now, and thought of it as a nice alternative to the kind of care we received in Waynesburg.  Everyone was clean and slim and spoke confidently about their prognoses and decisions.  We hoped we would get one of the especially kind doctors we’d had during our previous visits.

The young man who introduced himself to us was kind, but he was a young intern instead of a doctor and he nervously checked everything he did several times, often leaving the room to ask someone if he was going about things the right way.  “Food poisoning,” I said, certain of my diagnosis.  “Madchen harfed all over me just before we left and I think she’s got it too. They didn’t clean the forks at the Cracker Barrel.”  I was talking in half-thoughts.  It was, after all, nearly five a.m. by now.

“And what do you do, sir?” he asked.

“I’m working on my doctorate,” I said, and left it there.

Our strident internist looked into Melinda’s eyes, checked her vitals, and told her to go pee in a cup.  I couldn’t tell if his lack of confidence on the job was making him so jittery or if my presence was.  I stunk, I was bloodied, and I was still furious at the dogs.  “I want to kill them all when we get home,” I said. “Is that okay?”

The internist left to get his boss, whom he assured us would introduce himself as the internist’s boss.  I remembered him from Madchen’s last two visits to the emergency room.  Those times he burst through the curtains, announcing himself as the boss, looked at the charts, asked a few questions, reaffirmed that he was indeed the boss, and then signed our charts and told us to go home.  This time we were in a room without curtains so the bursting had to take place through a door.

Melinda had gone to the bathroom to throw up and Madchen and I were alone in the room.  I was trying to get her to sleep on the table, but she was sure someone was going to come stick a giant needle in her arm.  “I’m the boss doctor,” the boss said. “Where’s Melinda?”

“She’s puking,” I said. “What’s the prognosis?”

He and the intern looked at each other.  Then boss doctor rolled his eyes and burst back out of the room.

“We’re going to have to wait for Melinda to hear this,” the internist said.  He was sweating now, even though it was no more than 65 in the room.  I looked this poor guy up and down and imagined him eking out a living someplace like Waynesburg and thought to myself, “You’re never going to be a doctor. You’re just not made of the right stuff.”

“It’s not cancer, is it?” I said.  I suddenly felt like I might puke myself. “It’s that house. It’s full of lead and mold. Oh, Jesus,” I knew I would never outlive the guilt of having moved the girls into that house.  The internist said nothing, but unloaded more sweat from his brow in a show of empathy.

“Watch the baby,” I said, and I walked down to the bathroom.  I knocked on the door.  “Mel? They’ve got something they want to tell you.”

“I’m not pregnant, am I?”

“Pregnant? No, ha ha,” I said. “But I guess they’re worried about something terminal.”  I didn’t mean for it to come out that way, but neither one of us was really worried about anything deadly.  The whole night, our whole time in Morgantown, had fastened us squarely in the here and now.

“Kids are terminal,” came the response through the door.  I heard her vomit once more, flush the toilet, and then she came out into the hallway.  She was pale and yellowish and looked gaunt, but she was ready to hear the news.  “Where’s Madchen?”

“The doctor has her.”

“The boss?” She said, alarmed.  She remembered how it worked here.  I held her arm as we walked back down the hall to the room where we could hear Madchen screaming.  The internist thrust Madchen into Melinda’s arms and she asked:“Well?”

“You’re pregnant,” the internist said, and he released an enormous amount of air from his lungs as if he had been holding his breath the whole time I was gone.  He looked at us both, sweat shooting off his head in gobs.  “I have to leave you now.”

“Pregnant?” Melinda said.

I put my hand on her stomach.  No amount of misery could stifle the sudden electricity and revelation of that thrill. It was in there.  “Are you ready for a little brother or sister?” I asked Madchen.  There was nothing else I could ask of anyone.  Things had been rough and discouraging and I was determined to seize this moment as an omen of better things.

I was excited, but I also knew that we absolutely, positively had to move now.  While I rubbed my hand back and forth across Melinda’s stomach I had visions of finishing my PhD and moving out of Morgantown.  Of finding success as a doctor of creative writing and summoning a prescription for a better life.

“But I feel so pukey,” Melinda said.  She stared down at my hand as if that might be problem.  I came back down to earth, and began to smell the things I’d rolled in that evening.  I could smell Madchen’s vomit drying on her shirt.  Even if I never finished my PhD and got that better job, we had to move.  Seven in a house like ours would be the death of one of us.  Surely only the dogs would survive.  So I said to myself over and again that I would finish my PhD, we would move out of our house, and things were going to get better.

Just then the door flew open.  “I’m the boss doctor here,” he said.

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