“new” had been built a hundred years ago.

“Tell me why it is you’re looking for funding,” Mrs. Ketchem said as they rounded the corner onto Burgoyne Street.

“My folks can’t afford to send me,” he said. It was embarrassing, but at this point, he had rehearsed the details on so many applications and forms that it was almost as if he were talking about some other Allan Rouse. “I’m going to Albany on a scholarship, and working for my room and board. I’ve applied for scholarships and loans for medical school, but I haven’t been able to pull together nearly enough money to cover all the expenses. Plus, they only go through school. I’d be left looking for money to live on all over again when it was time for my residency.”

“Couldn’t you work while going to school?”

“Not if I wanted to learn anything.” He looked at her, willing her to understand. “Medical schools only accept the best of the best. You have to be there, giving one hundred percent every day, if you hope to keep up. I don’t want to just keep up. I want to excel.”

She cocked a graying eyebrow. “Why not sign on with the military? They’ll pay for everything. One year of service for each year of schooling, isn’t it?”

His fingers closed around the edges of Elliot’s coat. “I had an older brother who was in the marines. He died in Korea three years ago. It would just kill my parents if another of us joined up.”

“I’m sorry,” she said. They reached the corner of Pine Street, and she paused, the toes of her shoes hanging off the edge of the curb, while a dump truck chuffed past. “It’s hard to lose a child. Real hard. I can understand your parents’ point of view.” She stepped across the street and he followed, dodging the mucky gutters still wet with melted snow and the earliest spring rains. “Your parents used to live here, didn’t they?”

“Yes, ma’am. I graduated from Millers Kill High.” He tilted his head back to look at the sky, heavy with scudding gray clouds. “My dad worked at the mill until it closed down. They moved to Johnstown a couple years ago.”

“This town’s been going through some hard times. I don’t mind telling you, that’s one of the reasons I told Dr. Farnsworth I’d be willing to speak to you. I gave them the building for the clinic-practically had to ram it down their throats-and I gave them my in-laws’ farm that had come to me, so there’d be money to support the thing. But I can’t make the aldermen pony up enough money so’s to keep a steady doctor around. If it weren’t for the hospital staff doing volunteer shifts, we’d have to close it down.”

She fell silent. Should he leap into the gap? Tell her he was dying to come back to town as Dr. Rouse and take care of her clinic? She looked as if she was thinking about something. Maybe he ought to just keep his mouth shut.

They reached Elm Street. “Down this way,” she said. She continued on, saying nothing, as they strode down Elm. He loved this street, loved the deep, wide lawns and the shiny new cars he could see peeping from inside old carriage houses or parked beneath porte cocheres. The enormous elms that had astonished him as a boy were all dead now, and the immature saplings that had taken their place looked imbalanced against the three-and four-story houses. Still, this place had the same certainty that he had seen in a few of the kids at SUNY Albany, the ones who never had to stop and think about whether they could afford a pizza pie or walk back from an evening out because a taxi was too expensive. The certainty he wanted for himself. He wondered if any of the homes here belonged to doctors.

“Did Dr. Farnsworth tell you what I was thinking of?” Mrs. Ketchem’s voice snapped him back to attention, and his gut jerked, as if she had seen the thoughts inside his head and could tell he was no lily-pure altruist. “All expenses paid, room, board, tuition, books, what have you. During the school year and for three years of residency, which is what he tells me it takes to make a man into a doctor fit to look after the needs of a town.”

“Yes, ma’am. He and I talked about it after I got in touch with him.”

“And a year serving as the clinic’s full-time physician for each year of support. Same as with the military, although I can promise you you won’t get shot at here.”

They turned down a short two-house street and emerged onto Barkley Avenue. “There it is,” she said, pointing with her chin. He followed her gaze two houses down and saw… a house. It resembled several other houses on Barkley and Elm Streets, tall, narrow, made of brick and fancy wood trim. He had known Mrs. Ketchem donated her in-laws’ house to get the clinic started, but somehow, he had drawn a mental picture of something more… modern. Something that looked more like a medical facility and less like a place where someone’s rich grandmother lived. “It looks great,” he said.

“It’s pretty plain inside. I sold all the furniture and whatnots that my brother-in-law and his family didn’t want to keep. Used that money to fit out the waiting room and the offices. Got some local doctors to help out with medical equipment and stuff for the examination rooms, and what I couldn’t wrangle, the town bought cheap off the hospital when they did their renovation two years back.”

She escorted him up the walk. “Up there’s the only change I made that didn’t go directly into treating the patients.” She pointed to the granite lintel above the etched-glass-and-oak door. THE JONATHON KETCHEM CLINIC.

He was still digesting the news about their flea-market approach to equipping the place. “That was your husband? Jonathon Ketchem?”

“Yes.” The hard edges of her face softened. “This is his monument. I never did put one up in the cemetery. Some folks talked about that, you know. Said it just went to prove how cheap I was. But this…” She nodded approvingly. “No one in town has as big a memorial stone as this.”

He wished he knew the dividing line between being an eccentric and being a fruitcake.

“Well, let’s not hang around. Come on in,” she said, all business again. He opened the door for her and they went inside into a narrow front hall. He lunged for the interior door and managed to jerk it open a second before her hand fell on the doorknob.

Straight ahead of him was a staircase, sweeping up to a second-floor landing. The stained-glass windows and the gleaming woodwork looked as if they ought to be in a church, but the noise would certainly have been out of place. He pulled his eyes away from the stairs’ perfection and saw what was making all the hubbub. To his right, in what would have been the drawing room, at least a dozen people were sitting in sturdy wooden chairs that he swore must have come from the high school. One woman with a baby perched on her hip was trying to chase down a bratty little kid without actually breaking into a run and grabbing him. “You come right here this minute, Russell!” she hissed. Two old men who had evidently turned off their hearing aids were having a loud discussion about the benefits of red wheat versus winter clover. A teenage girl sitting next to an older woman kept popping her gum until the woman shrieked, “Will you stop that!”

Thumbtacked onto the walls behind them were simpleminded posters extolling the benefits of vaccinations, dental hygiene, and eating the five food groups every day. The only thing missing was the magic-bullet ad: Use a condom, prevent the clap. A wide wooden desk blocked most of the squared-off archway that would once have divided the front room from the family parlor, separating the two areas into waiting room and office. An old lady of the sweet and little variety manned the desk, a blue-and-white-striped apron over her street clothes.

“This way,” Mrs. Ketchem said, and he followed her down the hall, past the parlor lined with metal filing cabinets, and into a small room just the right size to have been a butler’s pantry. “This is the doctor’s office,” she said. It had no personal touches, no family photographs or diplomas on the wall. The desk and chair were cheap metal castoffs that looked like Army-Navy surplus. The single window, behind the desk, was half covered with an old-fashioned green roller shade, complete with thick silk cord and pull.

The enormity of what it would mean, seven years of his life in this place, broke over him like a massive wave. He would be thirty-five years old before he was released from his self-imposed bondage. One-fifth of his life would be spent coming here every day, walking past those idiot posters, saying hello to a succession of little old ladies in striped aprons, seeing patients with ingrown toenails and conjunctivitis and the flu.

He closed his hand tightly over the edge of one of the shelves that ran along each side of the office. Pantry shelves, he realized, once used for the family china and pots and pans. Now they were filled with anatomy books, medical texts, journals in grosgrain boxes. The books. Filled with things he wanted to know. He breathed in again, forced himself to relax, to look around with apparent approval. There were medical students who earned out their educations serving in big-city ghettos, or in Appalachian hamlets where all their patients had bare feet and married their cousins. Compared to that, coming back to Millers Kill would be a cakewalk.

“It’s great,” he said. “I admire what you’ve done here.”

“Come on upstairs. If they aren’t all in use, you can see some of the examining rooms.”

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