The stainless steel tongue depressor tin always rattled three times against the shelf whenever someone shut Examining Room Four with too much wrist. I sat at my desk with the chart for Mrs. Selly open to page two, waiting for the third rattle to die down before I went back in to check her blood pressure.

Dr. Aris Vance was the new man on the third-floor rotation, fresh out of residency down in Grand Rapids and carrying himself like a man who had memorized every footnote in Gray’s Anatomy.

He didn’t talk much to the nurses, and he had this habit of clicking his ballpoint pen twice before he asked a question, which drove Paulette up the wall by ten o’clock every morning.

Mrs. Selly had been coming to this clinic since before the bypass on her late husband’s heart, back when the linoleum in the waiting room was green instead of this dull gray tile we put in two summers ago. She was sixty-five years old, lived alone down on Maple Street, and spent her Tuesdays volunteering at the library behind the county courthouse.

The silence from Room Four had lasted about four minutes by my watch when the door didn’t just open, it banged against the drywall so hard the paper roll on the examination table tore itself another six inches.

I looked up from the requisition slips just in time to see Mrs. Selly come flying out like she’d seen a copperhead under the sink.

She wasn’t just crying; she was screaming, that thin, high sort of screech that old ladies make when the ground literally falls out from underneath them.

She ran right past the blood-draw station with her purse clutched against her ribs like a football, her gray hair shaking loose from its pins.

Dr. Warren Sterling, who had been practicing in this county since before Vance was in short pants, stepped out of the breakroom with a paper cup of lukewarm decaf in his hand. He nearly spilled the whole thing down his tie when Mrs. Selly nearly knocked him into the water cooler.

Warren caught her by both forearms, his coffee sloshing onto the baseboard heater, and asked what in the world was the matter.

“He told me!” she screeched, her voice cracking right in half as she pointed back toward the end of the hall. “That man told me I’m carrying a baby!”

Warren stared at her for three seconds, his jaw going slack in that way it did when a patient tried to tell him they cured their shingles with onion poultices.

He looked down at her swollen ankles, then back at her face, and honestly, the man looked like he had just swallowed a peach pit whole.

“Mrs. Selly, you take a breath,” Warren said, his voice dropping into that low, flat gear he used when he was trying to calm down a farmer who had just lost three fingers to a corn picker. “You go right on back to my office and sit in the leather chair by the window. I’m going to find out what’s going on.”

She didn’t wait for him to say it twice; she grabbed her handbag tighter and half-jogged toward the front exit, leaving the heavy glass doors swinging behind her like a pair of tavern gates.

Warren didn’t even finish his coffee. He set the paper cup right on top of the copy machine, which you weren’t supposed to do because of the vibration, and marched down the hallway with his white coat flapping around his knees like a sail in a gale.

I stood up from my desk because I knew trouble was coming, and when Warren gets that little red spot on the bridge of his nose, somebody is about to have a very bad twelve minutes.

He didn’t bother knocking on the door of Exam Room Four; he just shoved it open with the flat of his palm so hard the brass latch rattled in the frame.

Aris Vance was standing by the sink rinsing out a plastic measuring cup, still wearing those little wire-rimmed glasses that always looked like they were sliding down his nose. He had his clipboard tucked under his arm like he was standing at a bus stop waiting for the 4:10 out of town.

“What in the world is the matter with you?” Warren demanded, his voice bouncing off the white tile until my ears rang. “Mrs. Selly is sixty-five years old, she has two grown children and several grandchildren, and you told her she was pregnant?”

Warren took two steps into the tiny room, his chest puffed out like an old Plymouth out on Route 12, ready to read the riot act about basic bedside manner and forty years of community trust.

Vance didn’t flinch. He didn’t drop his clipboard, and he certainly didn’t look like a rookie who had just committed the biggest malpractice blunder in the history of the Maple Creek Family Practice.

He turned off the tap with two fingers, shook his hands once over the porcelain, and reached into his coat pocket for a fresh wooden tongue depressor.

“Does she still have hiccups?” Vance asked.

He didn’t look up. He didn’t even raise his eyebrows. He just stood there waiting for an answer to a question that made about as much sense as a screen door on a submarine.

Warren stopped dead in the middle of the linoleum, his mouth opening just a fraction of an inch before he snapped it shut again. The red spot on his nose went from a bright cherry to something that looked suspiciously like a bruised plum.

“What?” Warren said, and for once in thirty years of practice, the old man sounded genuinely rattled. “What in God’s name does hiccups have to do with anything?”

Vance finally lifted his chin, his eyes peering over the top of those wire rims with the flat, unblinking stare of a man who had spent four straight nights in the gross anatomy lab and forgot how human beings actually talked to each other outside of a lecture hall.

“Well, I told her,” Vance said, his voice as calm as a frozen pond in January. “I told her that if her hiccups didn’t stop by Tuesday, she’d probably be pregnant by Christmas. But she didn’t stick around long enough for me to finish the sentence about her husband’s vasectomy from twenty-eight years ago.”

I had to bite the inside of my cheek so hard I tasted copper, right there by the doorway.

Warren stood there for a long beat, looking at the young doctor’s clipboard like it was written in ancient Greek, while out in the waiting room the receptionist’s radio was playing some old tune about a heartbreak that nobody was going to fix today.