Alex
Two
My office is quiet, lights dimmed, jacket over the back of my chair. I’ve signed the last note and cleared the last lab result from the queue in the electronic medical record. I’m thinking about heading home when my phone rings. The emergency department.
It’s my on-call week.
“Of course. I’m on my way,” I say.
I hang up and start the long journey through the tangle of buildings on this hospital campus down to the ED.
The walk is muscle memory, so I scroll through the chart on my phone as I go.
Jim Patterson is the guy’s name. Stage III non-small cell lung cancer.
Active chemotherapy. His last infusion was twelve days ago.
There’s no recent imaging in our system, though I can see the notes on his care from his doctor in Vancouver.
Greyson’s notes say Jim has bilateral leg pain, tingling, and difficulty sleeping.
By the time I push through the ED doors, I’ve already built a short list of possibilities in my head.
The department is bright in that artificial way that makes it impossible to tell the time of day. Dr. Greyson stands near the central desk, scanning a chart, his sleeves rolled up.
“I’m glad I caught you before you left,” he says without looking up.
“I’m on call until tomorrow morning,” I answer.
He glances at me, and then a faint smile appears. “The fundraiser is tonight.”
“I know. I got all the emails and reminders.”
He nods toward a curtained bay. “He’s in four. We’re holding off on anything major until you weigh in.”
I step inside.
Jim is propped up in bed, thin from the cancer but still stubborn enough to hold himself upright. His wife sits beside him, one hand wrapped around his forearm like she’s holding him in place.
“Mr. Patterson?” I step closer and offer my hand. “I’m Dr. Spencer. I work with oncology here.”
“Call me Jim,” he says, voice rough but steady.
I pull the stool closer instead of standing over him. “Tell me what’s going on.”
He explains it in careful detail. The pain started as a tingling in his toes. Now it burns along his calves, worse at night. He shifts as he talks, wincing without wanting to.
I ask about the timing of his last infusion, any changes in medication, whether he’s had swelling, shortness of breath, new back pain. I nod along as he responds, making some additional notes.
“We didn’t want to mess anything up,” his wife says. “With what they’re doing in Vancouver.”
“You won’t,” I assure her. “That’s why I’m here.”
I review the protocol his specialist has him on and explain it back to them in plain language. The goal. The sequence. What the next few cycles are intended to accomplish. I make it clear that nothing we do tonight will interfere with that plan. If anything, it will support it.
Jim listens closely. He seems to want to understand the structure of the fight he’s in.
When I shift the conversation back to his legs, I can see the relief in his wife’s face. The cancer is the monster in the room. Leg pain is immediate and tangible.
“It sounds a lot like chemotherapy-induced peripheral neuropathy,” I say. “It’s a common side effect of the chemo, which can irritate the nerves in your hands and feet.”
“So it’s not the cancer spreading?” Jim asks.
“Based on what you’re describing, that’s not my first concern,” I answer. “But we’ll do imaging and some labs to be thorough. I don’t ignore new pain in someone with your history.”
Greyson steps into the bay as I finish examining Jim’s legs. He leans against the counter.
“What are you thinking?” he asks.
“Most likely CIPN,” I say. “But let’s get a Doppler to rule out a clot and basic labs. If imaging’s clean, we can adjust to symptom management and loop in his Vancouver team tomorrow.”
Greyson nods. “Sounds reasonable.” He scribbles something in the chart, and then looks at me again. “You going to make it tonight?”
“I’ll try,” I say. “Depends.”
“You always say that.”
“It’s usually true.” I shrug. “Like I said, I’m on call, so we’ll see how the night goes.”
I turn back to Jim and his wife. “We’re going to run a few tests to make sure we’re not missing anything urgent. If this is neuropathy—and I suspect it is—we can talk about ways to manage it. You don’t have to just live with it.”
Jim nods. “I appreciate that.”
I meet his eyes. “We’ll take good care of you tonight.”
When I step out of the bay, the orders are already placed, and the shift is done. But the work isn’t. That follows me out the door whether I invite it or not.
I make my way directly out to the parking lot.
I want to get home before I’m called back.
Yet for a moment, I just stand there, keys in hand, letting the quiet press in.
Inside, everything is fluorescent and urgent.
Out here, the world feels slower, as if it has no idea how much has already happened.
I unlock the car and slide into the driver’s seat. I don’t start the engine right away.
Jim’s chart is still open in my head. The rhythm of his voice when he asked if this meant the cancer was spreading. The way his wife didn’t look at me while I answered.
CIPN is manageable. It’s the most likely explanation, and the symptoms fit. The progression makes sense, and I know my assessment is sound. But that doesn’t stop my mind from circling everything else it could be.
I lean forward and rest my forehead against the steering wheel, my eyes closed against the pressure building behind them. Then I force myself upright, start the engine, and pull out of the parking lot.
The drive home is short, and as I turn onto my street, all I want is dinner and a quiet night with my family.
I cut the engine in the driveway and climb out of the SUV just as the front door swings open.
“Daddy!”
Eloise, my seven-year-old daughter, barrels toward me, throwing herself against me with enough force that I barely keep my balance as her arms lock around my waist. Her cheek presses into my stomach, and I drop my bag beside the door and bend down into her hug.
“Hey, you.” I ruffle her hair.
She drops her arms and moves her hands to her hips. “You’re late.”
“I had to stop at Emerge,” I tell her. “But I’m here now.”
She grabs my hand and tugs me toward the kitchen.
Zara, our live-in nanny and housekeeper, is pulling a tray from the oven, and the smell of roasted garlic and herbs fills the room. Zara has been with us since Eloise was still a baby, so she’s like part of the family.
“Perfect timing,” she says, glancing over her shoulder. “We’re just sitting down.”
A few moments later, on the counter is a platter of baked breaded chicken nuggets, a bowl of potato wedges, and broccoli. It’s a meal that would have been unthinkable in my mother’s house.
Back in Toronto, dinner was formal, often with a French flair.
Everything came in courses, one after the other, never overlapping.
Sauces were spooned with intention instead of poured, portions carefully measured, plates composed before they ever reached the table.
And the conversation was moderated as carefully as the food.
Thank heavens I left that behind when I moved out years ago.
I wash my hands and take my seat at the kitchen table.
“I helped,” Eloise announces, climbing into her chair and scooting it loudly against the floor. She reaches for a chicken nugget before Zara can stop her and adds, “I put the breadcrumbs on all of them. Not just some.”
“All of them?” I ask, pulling my napkin into my lap.
“Yes,” she says, lifting her chin. “Zara tried to help, but I told her I could do it myself.”
Zara arches a brow at me over Eloise’s head. “That’s not exactly how it happened.”
“It is,” Eloise insists, dipping her chicken into ketchup with careful precision. “I’m very good at coating things evenly.”
“That’s important work,” I tell her.
“It is,” she repeats seriously, nodding as if I’ve confirmed something official.
She piles her plate with chicken nuggets and potato wedges, ignoring the broccoli.
“Don’t forget the vegetables,” I remind her.
Zara covers a smirk as she steps out of the kitchen with a wave. She knows she’s welcome to join us, but she usually goes downstairs to her basement suite. I suspect she needs the break.
“I had carrots today.” Eloise doesn’t look at me.
“That’s good. Now you can have some trees.”
“I don’t like broccoli.” She ignores the bowl as if that will make it disappear.
“They help you to grow.” I spoon two florets on her plate.
She, in turn, squirts ketchup all over them and dares me to challenge her.
I don’t. They’re now covered in sugar, but at least she’ll eat them.
“Carrie was mean to me today.”
I pause. “Carrie?”
“My best friend,” she says, as if I should know this.
“I thought Wendy Wei was your best friend.”
“She is,” Eloise says impatiently, rolling her eyes. “But Carrie was too. You can have more than one. That’s normal.”
“Of course it is,” I say.
Eloise takes a bite, chews, and then swallows hard like she’s bracing herself. “Carrie said she doesn’t want to be my friend anymore.” She reaches for her milk and takes a long sip, eyes fixed on the table.
“What happened?” I ask.
“She said I was bossy,” Eloise mutters, pushing her broccoli into a small pile. “But I wasn’t.”
“What were you doing?” I ask.
“We were playing restaurant, and I was in charge because it was my idea. And then Carrie wanted to be the boss too.” She looks up at me, indignant. “You can’t just switch in the middle.”
“What did you say?”
“I said, ‘No, I’m the boss. You can bring the food.’” She shrugs. “That’s not mean. But she said she doesn’t want to be my friend if I’m going to boss her around.” Eloise presses her lips together. “So I said fine.”
“Did you mean it?”
She shakes her head. “No.”
“Then maybe tomorrow you can tell her that.”
She pokes her broccoli again and sighs. “Should I say sorry?”
“If you were a little bossy, you can.”
She thinks about it and gives a small nod. “Maybe I was a tiny bit.” Eloise chews her broccoli slowly. “Carrie said her mom helped her with her reading project.”
“That’s good,” I say.
“She always helps,” Eloise adds, something sharp in her voice. “Like, all the time.”
I nod but say nothing.
“My mom would probably help if she was here,” she adds quickly, not looking at me. “She’s just…far.”
“She would,” I say, though I have no evidence that’s true.
My ex, Anastasia, once blamed her lack of contact with me on the three-hour time difference between here and Toronto. And she’s never made any effort to follow up on her child. I know better than to expect anything from her, no matter where she is.
Eloise shrugs, pushing her empty glass toward the center of the table. “It’s fine. Zara helps.”
Anastasia is a selfish bitch. I’d regret every minute I spent with her, except she gave me Eloise.
“Do you think Mommy likes where she lives better?” she asks.
I keep my voice steady. “I guess she must. But I know she loves you. Where she lives doesn’t change that.”
Eloise studies me for a second, and then nods like she’s filing that away. “How was your day?” she asks, pivoting abruptly.
“It was good,” I say. “I got to tell a lady she doesn’t have cancer anymore.”
Her face brightens instantly. “That’s the best kind of doctor day.”
“It is.”
Zara is waiting by the sink when I step away from the table, stacking my plate with Eloise’s. She takes the dishes from me, brushing a crumb off my sleeve like she’s done it a hundred times.
“You’re heading out?” she asks, lowering her voice.
“For a bit,” I say, reaching for my jacket on the hook by the door. “That fundraiser for the hospital is tonight, and I need to at least show up.”
“I’ll be here.” Zara folds the dish towel over her hand and watches me shrug into my coat. “She’s in a good mood tonight.”
“I noticed.” I glance toward the kitchen where Eloise is now talking to her dolls.
“Have fun tonight,” Zara adds.
I slide my phone into my pocket, checking the screen out of habit. “Thanks.”
“And I’ll be around this weekend if you need me.”
“I appreciate it, but enjoy your time off tomorrow. Eloise and I have big plans this weekend. We’re going for a bike ride if the weather holds.”
Zara nods. “She’ll love that. She’s been asking if you’re coming to the class reading next week.”
I straighten. “I wouldn’t miss it.”
Eloise’s chair scrapes against the floor. “Daddy?” she calls.
I step toward the doorway. “I’m on my way out.”
She appears around the corner, wiping her hands on a napkin. “Are you coming back tonight?”
“Yes,” I say, crouching slightly so we’re eye level.
“Before I’m asleep?” She shifts from one foot to the other, pretending she doesn’t care about the answer.
“I’m on call, but I’ll try.”
She narrows her eyes but doesn’t argue. Instead, she steps forward and wraps her arms around my waist again, quick and tight.
“Okay,” she says into my shirt, as if she’s granting permission.
“Goodnight, bug.”
“’Night.” I step outside and close the door behind me.
The porch light throws a soft circle onto the steps. Inside, there’s warmth and noise and Eloise chatting away with someone who isn’t there.
I head down the steps to the car.