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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.”

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?”