It was gray and overcast on Thanksgiving morning. Snow was in the forecast for later that weekend, and from the limited weather reports Tricia had heard it looked like it was going to be the first big one of the year.

She still wasn’t sure how bad she wanted to horn in on the Compton family holiday, but Heather had been insistent, not only when the subject first came up but for several days afterwards. Finally Tricia caved in; it would be a couple hours at best, and would have some human contact involved.

Like a lot of places in small towns, the back door of the Compton house was more commonly used than the front door, and Tricia knew it from having been there before. Being polite, she rang the bell; in a few seconds Heather came to the door. “Dr. York!” she said in a strong voice. “How nice it is to see you! I was wondering if you were going to make it.”

Something in Heather’s words seemed a little strange to Tricia, and she knew what it was: although it had taken a little work to get through to her, Heather didn’t use Tricia’s last name and title outside the office. Well, maybe she’s showing me off a little, she grinned.

“Well, it’s nice to be here,” she replied. “I’m just glad you asked me, or I probably would have been opening a can at home.”

“Hey, while I’ve got a minute, there’s something out in the garage I need to show you before I get busy again,” Heather said, nodding slightly at the bustle of a couple of other women working in the kitchen.

“Sure, let’s do it now,” Tricia agreed. They stepped outside, and Heather closed the door behind her.

As soon as they were outside, Heather said, “Look, I’m glad you’re here, but I wasn’t expecting this. My Uncle John showed up, and I wasn’t expecting him.”

“Is this trouble?”

“I think so,” Heather said. “He’s been very lethargic for months, general pain, difficulty breathing. According to him, ‘I’m just old, I don’t need to see no damn doctor.’ Something’s wrong, I know it; hell, we all know it. When he showed up today, and I knew you were coming, well, I’m not looking for a physical or anything, but maybe you can show enough concern and friendliness to get him to come in and see you.”

“How old is he?”

“Eighty-four. He’s actually my great-uncle. Tricia, he’s really a nice guy, he’s got some neat stories to tell of the old days, but he’s slowly been sinking. Like I said, everyone can tell.” She took a deep breath and added, “I don’t think there’s much we can do for him at the office, except to get him to a specialist at Camden General. That probably won’t be easy. I’m just going to call you ‘Dr. York’ a lot to remind him you’re a doctor, OK?”

“The odds are you’re probably right, but I’ll give it a try,” Tricia agreed. What went unsaid was something both of them knew: sometimes, especially in older people, they figure they’d lived long enough and just gave up trying. That was especially true if they were dealing with a lot of pain or infirmity. It wasn’t exactly suicide, but it was the next thing to it. “I can’t promise you anything, though.”

“Sorry, but it’s the only thing I can think of. I didn’t think he was going to show up, but this might be the only opportunity.”

“OK, I can be cool,” Tricia agreed. “Just go in and introduce me around, and I’ll try to show some special interest in him.”

“Maybe that’ll work. It’s worth trying, anyway. I hate to put you on the spot like this, but thanks.”

Back inside, Heather introduced her as “Dr. York” to the women working in the kitchen, all some sort of relatives or other, and then the men and more women gathered in the living room, including ‘Uncle John,’ who was lying back in a recliner and not saying much of anything. The names came at Tricia so fast and furious that she knew she’d never get everyone straight. It was clearly a big extended family, though; aunts and uncles and cousins and who knew what from two different families, Russ’s and Heather’s. Some of the people didn’t know each other very well, and there were several conversations going on at once.

It was the kind of thing Tricia had never experienced before; her family in Los Angeles had been small, and in any case the family was falling apart by the time she was old enough to understand it. For years, holidays such as Thanksgiving had been mostly her and her mother, then her mother was gone as well. Since then, family holidays such as this had meant mostly envy of others to her if they meant anything at all. Although she was an outsider and didn’t know many of the common stories, it was still interesting and enjoyable to feel at least a little part of it.

After a period of hanging out with the women in the kitchen, Tricia sort of drifted into the living room, and, as luck would have it, found a chair not far from Uncle John. She took a glance at him from time to time, and it didn’t take much observation for her to come to agreeing with Heather: he didn’t look good, and without even the merest hint of an examination she could tell something other than old age was wrong with him.

He was polite, though, give him that. “How you doin’ today, Dr. York?” he asked.

“Oh, not too bad,” she replied. “It ought to be more interesting than sitting home by myself, which is what I would have had to have done. How are you?”

“Just getting’ old,” he shook his head. “Been feelin’ a little poorly of late, but I figure it ain’t nothin’ to be botherin’ a doctor about.”

“Well, we all have our down days, I guess,” she said, trying to ease her way into talking to him.

“Yeah, but when you get to bein’ my age, there ain’t many good days and a whole lot of bad days,” he replied. “Hell, I remember when I was half my age, I could work in the woods all day and go bust up the Pike Bar in the evening, then be ready to work all the next day without even a hangover. Now days, it’s just hard as hell to get out of my chair and go to the bathroom.”

In fifteen or twenty minutes, with many excursions into stories of logging in the woods and bar fights in the old days, Tricia had gathered enough history and complaints to get a much better idea of what the problem was, and frankly, it didn’t look good. What it came down to was that he was going to have to have a formal baseline examination, but it probably wouldn’t do much good. She suspected very strongly that what his problem was lay far beyond what she could do for him in a doctor’s office; it was going to take a specialist at Camden General. And, if she had to bet on what she knew, it would probably be a cancer specialist.

Though Tricia kept a small medkit – almost an expanded first aid kit with some other materials – in her car with her just in case she ran into something while she was out and around, she didn’t even think of bothering with it just now. It was clear to her that nothing worthwhile could be done with it, except to possibly piss him off badly enough that he wouldn’t come into the office in the first place. About the best that could be done was to tell him, “You ought to come into my office pretty soon. There might be something that can be done that would make you feel a little better.”

“Might have to do that, doc. I’ll have to think ’bout it.”

Somehow she doubted that would be enough, but at least she’d made the offer in a pleasant and non-threatening way. Maybe some of his relatives could bug him enough to make the effort, but again, based on their discussion, she doubted he had the motivation to try. About all she could do was to casually make the suggestion again from time to time and hope for the best. Really, she couldn’t do much more than that, anyway.

Soon it was time for dinner. The Compton house was a bigger, older one that had a large dining room, and that wasn’t enough space for everybody; the kids ate at the kitchen table, with some teenagers to keep them under control, while the adults gathered in the dining room for food and conversation.

There were plenty of both. Tricia had never seen such a feast! There had to be three times as much food than the total group of them could eat all day, maybe all week. The centerpiece, of course, was a huge turkey that Russ hacked up with an electric carving knife, but mashed potatoes, sweet potatoes, innumerable kinds of vegetables and salads, and things that defied easy categorization. Heather hadn’t made all of it, of course, not even most of it – various relatives had brought several dishes to contribute to the affair, and as far as Tricia could tell everyone brought a lot more than was needed. In fact, as far as she could tell, she was the only woman who hadn’t brought anything, and that was because Heather told her specifically not to, probably doubting spaghetti would go with the rest of the meal.

Of course, a lot of the conversation about various relatives past and present was beyond comprehension to Tricia, but she was also the focus of a lot of it. She was still the new doctor in town, and people were curious about her. She gave a lot of the standard answers she’d given at dinners around the town, and that seemed to satisfy a lot of the curiosity.

But having a doctor present meant that the conversation was going to stray to medical topics. Tricia was asked a number of questions along that line, and several times she had to say that there wasn’t much she could do here, but that an office visit would be a good idea. It was advertising as much as anything else; though the practice was growing, she wanted it to grow more.

Sooner or later she heard the line she’d heard from time to time: “Dr. York, it’s a shame doctors don’t make house calls anymore.”

“Really, it is,” she replied to the older woman across the table who had said it. “There’s a part of me that would like to be able to make house calls, at least in some special circumstances, but there are a number of good reasons and a few bad ones why it usually isn’t done anymore. Insurance has the most to do with it, of course, but the really big reason is that there are too many patients to see and often not enough time to see them all as it is.”

“I suppose that’s true,” the woman said. “I’ve gone to Dr. Metarie for years, and I always seem to have to wait for an hour or more to see him. And then he’s so rushed I don’t see much of him.”

“I understand perfectly,” Tricia replied, “although the wait isn’t as long in my office since I’m new here and I don’t see as many patients as he does, at least not yet. Dr. Metarie schedules six patients an hour, which really isn’t enough time with each one, but there are only so many hours in a day. So he often finds himself running behind, and I can understand why. He’d like to cut it down to five patients, or even four like we do, but he’s working fifty and sixty hours a week and still having to go down and visit patients in Camden on top of that. Now, if you go back to the real old days, when doctors used to routinely make house calls, they might see one patient an hour, or not even that. There’s just not the time to do it now.”

“Dr. York, I understand that,” the woman said. What was her name? Tricia thought. Eunice, maybe? In any case, it was just a guess and she thought she’d better not use it. “But sometimes it’s very difficult for someone to get out of the house to go see a doctor.”

“Yes it is,” Tricia admitted. “And it would be nice if we could bend a little bit on that, but other than exceptional or emergency circumstances, our insurance just won’t allow it. It’s very expensive, I know, to have a basic life support ambulance unit pick up a patient to bring them to the doctor, but that’s pretty much the way things have become. Now, that much said, things are being mitigated to some degree by home health care nurses, such as I understand Heather was for a while. They can provide basic care, monitor homebound patients, and they’re bright enough and experienced enough to spot developing problems and report them in time for something to be done. Things would be in much worse shape if we didn’t have them.”

“Evelyn,” Heather said – that had to be the woman’s name, Tricia thought in relief – “I worked home health care for several years. And, I agree with you, sometimes it would be very difficult for a patient to come into the office for a routine visit. I loved being a home health care nurse. I met some really interesting people, and they were always so grateful that someone had come to help them that it really made me feel good about what I was doing. Some of them are still friends. But I understand what Dr. York is saying, and she’s right. It just can’t be done. In fact, between Dr. York and Dr. Metarie, it’s getting harder and harder to see a doctor long enough for them to really get into a problem. Dr. York tries very hard to do right by her patients, and she’s doing pretty well with it so far, but I’m not looking forward to the day when she’s as busy as Dr. Metarie.”

“I’m not either,” Tricia admitted. “Finding Heather was one of the luckiest things that happened to me when I came here, because she can do routine things and buy me more time to spend with patients on important things. But I can see the day coming when that’s going to break down, too.”

“Dr. York,” Evelyn said, “I know you’re new in town, and I know they went through the very devil to get you here. And from what I’ve heard, you’re a very good physician. But for as much trouble as they went through to get you here, I can’t help but wonder what’s going to happen when Dr. Metarie retires.”

“It probably won’t be soon,” Tricia replied. “I’ve talked to him about it and he’ll probably stay with it a while, but probably not as long as Dr. Luce did. Still, I can’t help but think that sometime in the range of ten to twenty years I could very easily be the only physician left in town.”

“As busy as you are, Dr. York,” Heather said, “and as busy as I know Dr. Metarie is, I don’t see how you’re going to be able to handle it.”

“I couldn’t do it by myself. I mean, there’s no question, I couldn’t. But with any kind of luck, I won’t have to.”

“You mean we’ll have another physician? After all the trouble they went through to get you here?”

“Possibly, but possibly not, too. Things are changing and we’re just going to have to keep up with the changes. Local doctors like I am have always been the front line between patients and the medical system, but that day is going to have to change, and not just here. In ten years or so, I would not be surprised if medical care in this town, and anywhere else in the country for that matter, is going to be a clinic staffed with a physician and two or more physician’s assistants or nurse practitioners. They’ll be doing most of the routine patient contact, leaving the doctor to deal with difficulties. That’s the only way the system can survive.”

“It sounds good,” Heather said. “But I’ve seen PAs and NPs come and go at Dr. Metarie’s office, and heard him complain that there’s no easy way to keep them around.”

“I know; I’ve heard him say that, too. I think in time, what’s going to have to be done is to make our own, much like the deal that brought me here. Except, my feeling is that we’d start with people who want to stay in the community for other reasons. I’ve talked with Ryan Clark about that, and he’s starting to agree with me.”

“What do you mean?” Evelyn asked.

“I mean, start with an experienced RN, and fund her with the idea of her becoming a nurse practitioner. Or him, as the case may be, although I don’t know any male nurses in town. With some time, some online classes, and admittedly a year or more of clinical work that would have to be done somewhere else, over the course of several years a good RN could be turned into a good NP. Even one of them could take a huge load off my shoulders, and Dr. Metarie’s, as well.”

“I don’t know where you’d find someone like that.”

“I do,” Tricia smiled. “And she’s sitting right down at the end of the table. She does more than a little of that kind of thing for me right now, but there’s so much more she could do with the proper certification.”

“Dr. York!” Heather said. “Are you kidding? I’ve got kids, I can’t get away to do a year or two or more of classes and clinical work.”

“I didn’t say it had to be right away,” Tricia smiled. “I know you have little kids but they won’t be little for long. In ten years they’ll be out the door, or pretty close to it, and you could have most of the classroom requirements done by then, maybe through seminars, maybe through online courses. Maybe you could manage a semester every now and then, then break for a while. I do know there are programs that can be tailored to people in your situation.”

“But, Dr. York,” Heather protested. “It sounds good, but there’s no way Russ and I could ever afford to have me take off work to get more schooling, and then pay for the schooling, too.”

“Not a problem,” Tricia grinned. “Heather, how much do you want to bet I could get that taken care of with one phone call? The Donna Clark Foundation and the rest of the steering committee spent more than that to bring me here, with no real guarantee I’d stay more than five years. I may stay, or I may not. There’s no way of telling yet. They’d stand a good chance of getting a nurse practitioner who’d stay here for a lot longer than that, even if it took you a few years to get qualified.”

“I . . . I never even thought about that.”

“Well, think about it,” Tricia grinned. “Look into it, give it some real study. If you decide you want to do it, I’ll make that phone call.

The office was open on the day after Thanksgiving, although it wasn’t very busy. Both Tricia and Gene had been a little concerned about both offices being closed for a long period over the holidays, so they’d worked out a deal for one of them to stay open and cover for the other one in an emergency. The plan was that they’d trade off; Dr. Metarie would be open on the day after Christmas, while Tricia took that day off.

Since they hadn’t planned on being busy, Molly had the day off, too; the next time they had to be open on a nominal holiday, the plan was that Heather would take off, Molly would work and Tricia would do what she could of Heather’s work as necessary.

As it happened, it worked out well, because Tricia and Heather had a lot to talk about.

“Thanks for mouse-trapping me in front of my whole family,” Heather complained at the first chance she got. “Now I’m going to have everybody bugging me to do it.”

“Well, I promise to not bug you about it,” Tricia told her. “But it strikes me as a darn good idea. First off, you know this stuff. You’re a damn good nurse, and you see things a nurse wouldn’t normally be expected to see. You’re pretty damn smart, and I can’t believe you wouldn’t breeze through the training with your background.”

“Tricia, it sounds good but I can’t take off from my family like that.”

“Sure you can. Maybe not right now since your kids are so young, but in a few years? Hell, you may enjoy having the break to do something else when you get that far.”

“Well, maybe,” Heather replied dubiously.

“You might want to look into something else,” Tricia suggested. “I don’t know the details as they apply to you, but it might be easier to become a PA than it would be to become an NP. Like I said, it deserves some investigation.”

“Well, maybe, but what difference would that make?”

“Oh, there was a thought that happened to cross my mind,” Tricia replied with an evil grin on her face. “You remember telling me how kids put you down and made your life hell because you had Lee so young.”

“Yeah, some of that shit still hurts, too. I still get some of it.”

“Then think about this,” Tricia grinned. “How are you going to feel when one of those assholes comes into the office and has to call you Doctor Compton?”

Heather was silent for a long time. “Yeah,” she said finally. “That would feel pretty good, wouldn’t it? I mean, even if it only happened once.”

“I don’t know who it was that said that living well is the best revenge,” Tricia laughed, “but maybe they got it right.”

“I’ll look into it,” Heather said. “I mean, seriously. No promises, but I’ll look into it.”

“Can’t ask for more. I’ll tell you this much, you have to want to do it, not just let it happen or it won’t work. You’ll have to want to do it as bad as you wanted to be a RN. Maybe even more.”

They talked about it for a few minutes, but had to break off when a patient came in. It took a while before they were able to talk again, this time over a cup of coffee. “So,” Tricia said, “I haven’t seen your Uncle John on the schedule.”

“No,” Heather sighed. “I know Aunt May and some other people are going to work on him, especially after what you said yesterday. But honestly, I doubt if we’ll see him. He just has his mind set against it and thinks it’s getting to be about his time.”

“I got that impression. But without being able to examine him, and maybe have a specialist examine him, he could well be right. Sometimes you can just sort of smell cancer, sense it. No reason, you just can. If I had to bet knowing what I know now, that’s how I’d bet. What’s more, again without a real examination, I’d be willing to bet he’s so far gone with it there’s not much anyone could do.”

“That’s been my gut feeling, too,” Heather sighed. “But I guess there’s no way we can drag him in here, or down to Camden General to find out.”

“Yes, and maybe too bad. But honestly, when it comes right down to it, it’s not our decision to make. Heather, one of the hard things I had to learn is that you can’t always make someone want to take care of themselves, no matter how much you’d like it to be that way.”

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