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“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.”

He followed her up the grand staircase and down the second-floor hall. “Here’s where we’ve put in a ladies’ room,” she said, pointing to the first door on the left. “Ran the piping up from the kitchen belowstairs. Men’s room is the old second-floor toilet. I figured they didn’t need the space the women did. This one’s taken, this one.” She pointed to the closed doors as they walked past. “Here,” she said, entering through the last door in the corridor. It was an examining room. Plain, but with everything he’d expect to see. The wooden floor had been replaced with linoleum. She saw him looking at it. “The doctors said you can’t keep wood sterile. This stuff can be scrubbed down with hospital-strength disinfectant.”

For a moment he wondered if the clinic’s doctor would be responsible for that job, too.

Mrs. Ketchem crossed her arms and looked out one of the room’s two windows. “This house belonged to my husband’s grandparents before it came to my in-laws and then to me. Grandmother Ketchem was some house proud. Sometimes I can’t help but imagine those old folks rolling in their graves at some of the things I’ve done to this place.”

“Why?” Allan couldn’t restrain the question that had been swelling inside him since he had first seen her dumpy house on Ferry Street. “I mean, I know it’s great to give away money and all, but most folks who do it are rich. Didn’t you want to keep this house for yourself? Live, you know, in style?”

She didn’t answer him right away, and he wondered if he had just blown it, by showing that he was not the sort of person who would give away riches as soon as they fell into his hands. “I gave birth to my first child in this room,” she finally said. She let her gaze roam over the walls and windows, as if she were looking through time, to the way it used to be. “We had a farm out in the Sacandaga River valley, a good half day’s ride by horse and cart, which was all we had. So when my time came near, my husband brought me here, into town, to stay with his grandparents. It was in here I had my son Peter.” Her voice had gone all thin, as if it were coming from a long way away.

She looked straight at Allan. “I’m going to tell you something I don’t speak of, because I want you to understand what this clinic means. What it’s for.”

He nodded, desperately curious and afraid of what he might hear, both together.

“I had four children once, in that farm. It’s all gone now, children, farm, everything. But back then, it was my life. I never thought it wouldn’t all go on like it had, each day following the one before.”

He nodded again, feeling that he ought to make some acknowledgment.

“It was March, in ’24. It had been a cold March, like this one, after a cold winter. Jonathon had taken our two oldest to a party, one of our neighbors who lived upriver. I figured they must have gotten it there. Some of the older kids came down with it, but they recovered after a bad croup. It works that way, you know. Once they’re eight, nine, ten, it mostly sickens them. But younger, it kills. My Lucy and Peter were the youngest there that day.”

Allan wanted to sit down, but his legs seemed nailed to that spot on the linoleum floor.

“About two days later, they both came down sick. It could have been most anything. They were feeling poorly, with a cough and a fever. Their coughs got worse and worse, and I could see how bad their throats looked, all white and red, and them pulling for breath and spitting out nasty mucus. I stayed up all night for two nights running with both of them, steaming ’em, making potash gargle, giving them saltwater drops to keep their noses clear. Then the next day, they seemed to be on the mend. Both of them terrible weak, but their throats clearing up and their breath coming easier. I had kept the two younger ones away…” She looked out the window again. “Three days after Peter and Lucy got over the worst of the coughing, Mary and Jack came down with it. But it was worse, so much worse. It went through them like wildfire. High fevers, and their little throats all swollen and choked. They couldn’t hardly breathe. It was when I saw their throats and tongues all dark that I couldn’t deny anymore that they had the black diphtheria. You know what they used to call the diphtheria, don’t you?”

Allan tried to nod. “The Strangler,” he said.

“That’s right. Jack died by the next morning, died hard, fighting it with everything in him. And then that evening, my little Lucy. Her heart stopped. That’s what it does, you know. If it doesn’t choke off the breath and blood, it paralyzes the heart.”