Chapter 6

The Marshall Medical Group Family Practice Clinic took up the better part of the second floor of a four-story medical, dental, and legal building in east Roseville. Ken arrived ten minutes before his scheduled appointment time on Thursday morning. There were perhaps twenty people sitting in chairs in the waiting room, most of them elderly, or at least well past fifty years of age. Two receptionists were working the check-in counter, both attractive young women in their early twenties dressed in borderline unprofessional business attire that showed a considerable amount of cleavage. Behind them, a small gaggle of other women, most dressed in scrubs, sat behind desks and talked on wireless headsets and tapped away at computer terminals. There were three people waiting in line to check in: two elderly women and one man in his late forties. Ken got in line behind the man, suppressing the urge to inform him that it was quite unfashionable to dress in khaki shorts, white tennis shoes, and black socks. He figured if he mentioned that, however, he would also be forced to mention that the comb-over was not fooling anyone, so he kept his views to himself.

The line moved slowly forward. Next to the signs that declared Visa, MasterCard, and American Express were accepted here and that checks should be made payable to MMGFPC was another sign that declared: Patient Confidentiality is our Prime Directive! When Mr. Comb-over with the black socks was called forward the blonde receptionist looked at his chart and declared loudly: "You're here to see Dr. Stinson for the bleeding hemorrhoids, right?"

"Uh ... yeah, right," Comb-over said in a quiet voice.

"Very good," Blondie told him. "Do you still have Blue Shield?"

"Next," said the other receptionist, this one an artificial redhead whose artificial boobs were both wildly out of proportion to the shape of her body and nearly falling out of her blouse.

Ken walked up to her, noting that the smile she gave him seemed more than the counterfeit professional one she reserved for the other patients. "Hi there," she said, her green eyes (which were fake as well—he could see the lines of the contacts) looking him up and down in an approving manner. "Are you here to see the doctor?"

Why else would I be here? Ken did not say. "Uh ... yes. I have a ten-thirty with Dr. Adrial."

"Which Dr. Adrial?" she asked. "Ben or Steve?"

Ken always forgot that there were two Dr. Adrials here. They were the brothers who had founded the practice nearly twenty years before. Now, of course, there were no less than six doctors and twice as many nurse practioners working for the practice. "Sorry, Ben," he said.

"Oh, that's quite all right," Red said with a giggle. "Happens all the time. And what's your name?"

Ken told her. She punched it into her computer and looked at the screen for a few moments, her smile growing a little wider. "You're a pilot, huh?" she said brightly (and quite loudly). "Pilots make pretty good money, don't they?"

"Some do," Ken said. "And some don't."

"I just love to fly," she told him. "I don't get to do it very much though. What kind of plane to you fly?"

"Just a cargo plane," he said. "Nothing big."

"Do they let you give people rides?" she asked, her eyes looking at him hopefully.

"No," he said, shaking his head. "It's against FAA regulations."

"FAA? Is that the company you work for?"

"Yeah," he said after a moment's pause. "That's them. They're almost as bad as the federal government, you know."

"Wow, I guess so," she said respectfully. "Oh well. What brings you to see Dr. Ben today?"

"There was something in my blood work he wanted to see me about."

"Really?" she said. "What was it?"

"Uh ... I don't know. That's kind of why I'm here."

"Ohhh," she said as if he'd just told her the secret of multiple orgasms. "I see."

"I'm glad," he said. "Shall we check me in?"

"Right," she said, her fingers going to her keyboard. She quickly confirmed for the record his full name, his date of birth, his address, his phone number, and his insurance information by blurting it out to him. She then batted her fake eyes and shook her fake boobs a few more times. When she got no response from this, she gave a little "hmmph", as if to say, "must be gay or something" and told him he could have a seat in the waiting room where he would be called shortly.

"Thank you," Ken told her. He found a seat near the back.

"Shortly" turned out to be twenty-three minutes. He sat and watched The Lion King on the room's television set (why The Lion King was being played was a mystery to him since he was the youngest patron of the office by at least ten years) while Blondie and Red loudly shared the name, address, phone number, insurance coverage, and chief complaint of every patient that stepped up to the window. Finally, a door opened and Ken's name was called. A young blonde girl with a nose ring and a tongue piercing walked him inside the main office. Once in there, she weighed him and then led him to exam room number six where she took his blood pressure and pulse and subjected him to another mini-interrogation about the purpose of his visit. Once done with these tasks, she told him the doctor would be with him shortly and shut the exam room door on her way out, leaving him alone with his thoughts.

This time it was only eighteen minutes before the door opened and Dr. Ben walked in. He was fifty years old or so, slightly overweight, with a full, thick head of transplanted hair. He wore the requisite white lab coat and had the requisite six hundred dollar stethoscope hanging around his neck. In his hands he carried a small clipboard upon which was a form that had been generated by Red the receptionist on her printer and filled in by the pierced medical assistant.

"Mr. Patterson," Adrial said pleasantly, professionally, without the slightest hint of recognition despite the fact that he had examined Ken every three months or so for the past four years, including a routine exam less than ten days before. "What brings you to us today?"

"You did actually," Ken said. "Apparently there was something amiss in my blood work so you had Pepsi call and make an appointment for me."

"Okay then," Adrial said, nodding, still with no sign of recollection of having done that and no air of apology for not remembering it. "Why don't we have a little look at your chart then?"

"Why don't we?" Ken said, suppressing a sigh. This was what family practice medicine had become in the last ten years. The doctors saw 20-30 patients a day, 100-150 a week, and remembered nothing about any of them. Ken would have found another doctor long ago if he thought the situation would be any different at another office.

Adrial went to the computer terminal in the corner of the room and typed in Ken's name and date of birth, bringing up his chart. He perused the demographic page for a moment and his eyes lit up some. "Oh," he said, "So you're a commercial pilot?"

"That's right," Ken said.

"What do you fly?"

"A-300s out of Mather," Ken said blankly. He had given this information to Adrial no less than five times now.

"Ahh, here it is," Adrial said, looking under the employer section of the demographics. "Early Bird Cargo, huh? I have another patient that flies for them. Can't remember his name right now. I remember him telling me he worked the night shift flying to Omaha."

Jesus Christ, Ken thought, exasperated. He remembers the goddamn conversation I had with him a few months ago, he just doesn't remember it was me who held it with him. "You're probably thinking of John Smith," he said, pulling a name out of his butt. "He works the Omaha line and I seem to remember him saying he was one of your patients."

Adrial thought this over for a second and then nodded. "I think maybe that was the name," he said. "How is John doing?"

"Couldn't be better," Ken said.

"Good, good," Adrial said, happy. "I know how important having a clean bill of health is to you pilots. Did I ever tell you I'm a pilot myself?"

Only about fifteen times, Ken thought. "Yeah, I think you mentioned it. You fly a Cessna 170 out of Lincoln, right?"

"That's right," Adrial said. "Did I ever tell you about the time I came in at night and my alternator was out? Batteries were flat as a pancake and the radios went dead. Couldn't get the landing lights to come on down on the strip because, you know, clicking the radio is what turns them on. Had to land in the dark."

Ken chuckled, as if the story was funny and not a horrifying example of a moronic pilot who shouldn't have been allowed to even play Flight Simulator on his computer, let alone fly a real plane. "Yeah, you told me that one, doc. Pretty damn hairy."

"I managed to pull it off though," Adrial said, feigning the wiping of sweat from his forehead. "I'm sure you have some pretty good stories of your own."

Ken shrugged. "Nope, not really," he said. "My career has actually been kind of boring so far. Hopefully it'll stay that way."

Adrial nodded wisely. "That's a good attitude to have," he said. "Now then ... let's take a look at this blood work." He made a few clicks with the mouse and stared at the screen. "Hmm," he mumbled. "Lab results ... lab results ... oh, here we go." He stared silently for a few seconds and then started nodding. "That looks okay ... that looks okay ... hmm, a little elevated here." A few more clicks of the mouse, another minute of perusal. "Okay ... okay ... very interesting."

"So how does it look, doc?" Ken asked. "Is my cholesterol up again?"

"Well, your cholesterol numbers are actually looking better than they were in your last blood draw in February," Adrial said. "Your HDL, or good cholesterol is up to 43 from 28 and your LDL, or bad cholesterol, is down to 168 from 190. Still a little higher on that LDL than we really like to see, but better. Did I start you on a statin at your last visit?"

"You tried," Ken said, "but I refused it."

"You refused it? Whatever in the world for?"

"I'm only thirty-eight years old. I don't want to start taking those statins while I'm so young, especially not for a borderline high cholesterol level."

"It is true that you're only borderline right now," Adrial said, "but we really ought to get you on a statin prophylacticlly at this point. It will bring that LDL down around a hundred or so in no time."

"Why don't we wait a few more months to see what that LDL does on its own?" Ken said. "My wife and I have virtually cut red meat and dairy completely out of our diets and we've been eating enough fish to keep a small feet of fishing boats in business. Since my numbers are better, our dietary changes must be working, right?"

"Well ... I suppose," Adrial said doubtfully. It was obvious he was not used to patients turning down prescription drugs. After all, this was the era of the 'talk to your doctor about xxx and see if it's right for you' commercials.

"So," Ken said, "If the cholesterol numbers are improving, what labs did prompt you to have me come in?"

"Oh ... right," Adrial said, turning back to the computer screen. He perused again. "Oh ... this must be it. Yes, it is. I made a few notes here when I reviewed your labs." He looked up at Ken. "Your blood glucose level is a bit elevated. And it looks like this is something of a pattern."

"What was it?" Ken asked.

"122 milligrams per deciliter of blood," Adrial said. "Not bad if we're talking about a mid-day blood glucose level, but a bit worrisome for a fasting blood glucose. You were fasting when they drew the labs, right?"

"Oh yes," Ken confirmed. He knew the drill for lab draws quite well. Eat nothing and drink nothing but water after eight o'clock the night before and go to the lab first thing in the morning along with every other schmuck getting a cholesterol test drawn. The sensation of an empty stomach and a hunger headache would forever be associated in his mind with crowded waiting rooms, the smell of rubbing alcohol and the sting of a needle in his arm.

"We generally like to see that number below 100 for a fasting glucose," Adrial told him. "And looking over your past three draws, it's been 104, 108, and 114 respectively. Now it's 122. This is telling me that you're well on your way to a diagnosis of type two diabetes."

Ken was suddenly very nervous. "Doc," he said. "You're not thinking of putting me on meds for this, are you?"

"You're really opposed to taking prescription medicines, aren't you? You shouldn't be afraid of these drugs, Ken. You should be grateful that modern medicine has developed a way for people to live normally with certain afflictions."

"This is a little different than the statin drugs, doc," Ken told him. "If I have to take pills to keep my blood sugar under control I'll lose my medical certification to fly. Flying is how I make my living, remember?"

"Hmm," Adrial said, nodding. "I suppose I can appreciate your dilemma. In any case, I'm not quite ready to start you on oral hypoglycemics just yet. I do, however, want to keep a very close watch on your blood glucose levels."

"What do you mean? More frequent lab draws?"

"No, not exactly. What I'm going to do is write you a prescription for a glucometer. That's a small glucose monitoring device you can use at home. You can pick one up at your drug store and your insurance will pay for most of it."

"That's the thing where you poke your finger and put a drop of blood on it?" Ken asked.

"That's right," Adrial confirmed. "I'll give you a log book and have you start tracking your readings. I'll want you to check your sugar three times a day: when you wake up in the morning, at mid-day an hour after lunch, and right before bedtime. Do that for ... oh ... say eight weeks and then come back and see me with the log book and we'll decide what to do from there."

"Okay," Ken said slowly. "And what kind of readings are we looking for here?"

"We want to see morning glucose levels at around 100, afternoon levels below 150, and evening levels below 160. If your morning readings are consistently above 120 or the other readings are consistently over 180, or if you're ever over 200, then we need to start talking about doing some further workups and getting you on some medicine."

"I see," Ken said thoughtfully.

"And to help you out with this, I'll give you some handouts about the proper diet you should be following to keep those glucose levels nice and steady and within parameters. I don't know if you're going to be able to get your readings down with diet alone—after all, if your pancreas is failing then your pancreas is failing—but in order to try you're really going to have to make a big change in your eating habits. You need to cut out alcohol entirely, cut your carbs down to almost nothing, and lay off anything that has a lot of sugar in it."

"Great," Ken said with a sigh. "I get to eat even more boring than I already do."

Adrial gave him an apologetic look. "It's all a matter of what's important to you. Do you want to eat, drink, and be merry like you always have, or do you want to go on pills and possibly insulin and lose your medical certification?"

Ken nodded solemnly. "Yeah," he said. "I hear you, doc. I hear you."

Two hours later, Ken sat on the couch next to Meghan, his new glucometer and all of the supplies associated with it spread out on the coffee table before them. There was the glucometer itself, which was about the size of a cellular phone; the case it was stored in; a round cylindrical container of plastic strips for the blood to be put onto (perversely, these had been the most expensive part of the whole set-up); a small jar of sharp pins imbedded in plastic to extract the blood from a finger; and a spring-loaded pen that fired the sharp pins imbedded in plastic into said finger to extract said blood.

"Okay," Ken said as he slid a master strip into the machine to calibrate it to that particular container of strips. "It seems to be ready."

"Go ahead and try it out," Meghan told him. "Let's see what your first mid-day reading is." Meghan had given him an interrogation worthy of a third-world dictatorship the moment he'd walked in the door. He had tried to downplay the seriousness of the situation as much as he could but had not omitted any information from her. As such, she was worried about him, though trying not to show it.

"Shouldn't I wait until tomorrow morning to start this monitoring program?" Ken asked. He wasn't really looking forward to jabbing a pin into his finger.

"No, you wimp," she said. "You should do it now to make sure the damn thing works right."

"But it's only been about forty minutes since I ate," Ken said. "I should at least wait another twenty."

"Wassa matter?" she said with mock contemptuousness in her voice. "Afraid of a little prick on the finger?"

"All right," he said, responding, as Meghan had known he would, to the implied challenge to his manhood. "Let me load up this poker thing."

It took him a minute or two to figure out how to get one of the pin imbedded in plastic devices into the spring-fired pen. Finally, after a few wrong insertions, he completed the process. He then pulled back on the cocking mechanism and it locked into place.

"Locked and loaded," he said.

"Okay," said Meghan, who, unlike her husband, had actually read the directions, "Now you put it up against the pad or side of a finger and push the release button."

"Does it say what finger?" he asked.

"It says you should alternate fingers to keep calluses from forming."

"What about for the first time?" he asked. "Should I start with one particular finger and come up with a rotation?"

She looked at him with a semi-glare for a moment, opened her mouth to say something, and then thought better of it. Instead, she picked up the directions again, pretended to look at them, and then said: "It says you should start with your left pinkie finger and work your way to the right."

"Does it really say that?" he asked.

"Yes," she said. "It really says that."

"Let me see those," Ken said, holding out his hand.

"Would you just poke your goddamn finger!" she barked.

"Okay okay," he said. "You don't have to yell."

He put the tip of the pen against his left pinkie. Wincing in advance, expecting a huge, monstrous pain to go shooting up his arm, he pushed the release button. There was a clicking noise and a small, almost unfelt pinch in his finger. It was so small, in fact, that he thought the device had misfired. He pulled the pin away from his finger, prepared to cuss and go through the loading procedure again, but, to his surprise, he saw a small bead of blood on the tip of his pinkie.

"How was it?" Meghan asked.

"It hurt," he said. "It hurt a lot."

"It did not," she scoffed. She picked up the directions. "Now you ... oops."

"What do you mean, oops?" Pilots were not particularly fond of hearing that word.

"Well, we kind of missed a step here. You were supposed to put one of the strips in the machine first."

"Oh ... I suppose that makes sense," Ken said. "Some navigator you are."

"Hang on," she said, fumbling with the strip container. She pried on it and finally got it open. She removed one of the strips and plugged it into the slot in the machine. The machine turned on automatically, blinked a few times, and then read: Apply Blood Now. "Here you go."

Meghan held the strip out and Ken touched the drop of blood to it. The strip seemed to suck the blood drop right off of his finger. The screen changed and a twenty second countdown began. They watched in nervous anticipation until it reached zero. A number then appeared on the screen. It was 172mg/dl.

"172," Ken said slowly. "That's below 180."

"But higher than 160," she said.

"Yeah," he said blankly.

"Maybe it's because you didn't wait an hour after eating," Meghan suggested. "Remember, we were just testing the thing out."

"Yeah," he said. "Just a test. No sense in even writing that one down."

While Ken put a tissue on his bleeding finger and applied direct pressure, Meghan threw away the used strip and the used poking device and stowed everything back in its proper place. By the time she was done, Ken had his hemorrhage under control. They sat back on the couch, not saying anything.

"Let's start doing this new diet right away," Meghan said. "We'll cut out the bread, cut out the booze, cut out the sweets. Chicken, fish, and vegetables only."

"You don't have to follow the diet, hon," Ken told her. "Your pancreas is working like it's supposed to."

"I know," she said, "but I want to go on it with you. I can always stand to lose a few pounds, and remember, my cholesterol was even higher than yours. It'll do both of us good."

He looked at her, touched by the gesture. "That's very sweet of you, hon. Are you sure you want to do this? You looked at that list of acceptable foods and proportions. It's the most boring diet known to man."

"I'm sure," she said. "You don't think I want to have to prepare two goddamn meals on my cooking nights, do you?"

He smiled. "Well, as long as there's some self-interest involved I feel better about it." He leaned over and kissed her softly. "I love you."

"I love you too," she told him. "Should we start this thing tonight? I was going to make the almond chicken but I can use the chicken breasts for something else. Maybe a nice chicken salad?"

"No, actually I have a better idea," Ken said.

"Yeah?"

"Yeah," he said. "Why don't you leave those chicken breasts in the refrigerator for now?"

"And have fish?" she asked doubtfully. "I don't have any thawed out."

"No," he said. "No fish. You're off the next two nights. So am I. I'm thinking that before we start this new ... lifestyle, we should have one last hurrah of the old lifestyle. And I mean the old old lifestyle, before the cholesterol readings and the high blood pressure and the torture chamber we call the gym."

Her eyes were showing interest now. "Oh yeah?"

He smiled. "Yeah."

Two hours later, Ken and Meghan were each astride a 2004 Harley-Davidson Road King Classic, heading east on Highway 50 toward the Nevada state line and the casinos of South Lake Tahoe. Meghan's bike was crimson red, Ken's vivid black, their helmets perfectly matched to their respective bikes. Both wore denim jeans and short-sleeve T-shirts tucked in at the waist. Their saddlebags contained small pieces of luggage with extra clothing and toiletries. They were just past the town of Placerville and starting the long, twisting climb into the Sierra Nevada Mountains, their engines purring with nearly 1600 cubic centimeters of power.

The ride was soothing and therapeutic for both of them. Since it was a Thursday afternoon, the road was almost deserted of traffic. They did not have to slow down for RVs struggling up the grades or timid drivers going too slow around the curves. They were together and doing something they enjoyed but unable to communicate on a verbal level, forcing them to use fleeting looks and occasional hand signals to get their messages across to each other. They didn't mind. Correct destiny couples did not always need words to talk.

Eighty-nine minutes after putting out of their driveway, they reached Echo Summit, the highest point of their journey. The view eastward from the nearly 7400 foot elevation was magnificent, even to a pilot used to seeing things from up high. The sparkling blue water of Lake Tahoe lay spread out far below, surrounded by the rugged peaks of the eastern Sierras. From there, they started down a steep incline full of switchbacks. Ten minutes later they were entering the South Lake Tahoe city limits. Ten minutes after that, they crossed into Nevada and were in the town of State Line, surrounded by high-rise casinos.

They parked their bikes in the parking lot of the Pioneer Towers Hotel and Casino, a twin tower complex that had been built on the site of an older casino five years before. They removed their bags from their saddlebags and put their helmets inside in their place. After locking the saddlebags and making sure their handlebars were secured, they walked hand and hand to the main lobby entrance of the hotel, chatting amicably about the sights and smells they'd encountered on the ride.

Ken noticed immediately that the lobby was a little more crowded than he had been expecting. The South Lake Tahoe casinos were typically almost deserted on weekdays in these modern times, the victims of increasing competition from Indian casinos down in the Sacramento region, casinos that were much closer to the core gambling demographic and much more heavily advertised on local media.

"What are all these people doing here?" Meghan asked, looking around in wonder. "The last time we came up here it was almost empty—and that was on a Saturday."

"I don't know," Ken said, starting to worry a little now. Figuring that the place would be desolate, he had not bothered to call ahead and make sure there was a room available for them.

They soon found out what all the people were here for. The Fourth Annual Tru-West Wireless Classic LPGA golf tournament had started today at the nearby Sierra Vista Country Club. Players, their support staffs, media types, and fans had streamed into the resort town from all over the country for the event.

"You really should have called ahead for a room," the young brunette desk clerk told Ken apologetically when he enquired about lodging. "This is one of the few weeks of the year where we're typically quite booked up."

"Maybe we should start calling around to the other hotels," Meghan suggested.

"You can try," the clerk said doubtfully, "but the other hotels usually fill up first because they tend to be less expensive than we are."

Meghan looked dejected at this news. Ken understood. "Look," he said to the clerk. "Do you have anything available? Anything at all? We'll take a storage room next to the kitchen if you have it."

"Well ... let me see," she said, going to her computer. She typed a few commands, stared at the screen for a moment, and then put an apologetic look on her face. "I do have a cancellation on a mini-suite for tonight but ... well ... it's kind of pricey."

"How pricey?" Ken asked.

"It's $453 for the night," she said, almost whispering the amount.

"Wow," Meghan said with a whistle. They had been planning on spending no more than sixty dollars for their room.

Ken made an impulsive decision. "What the hell?" he said, pulling out his wallet. "We'll take it."

Meghan looked sharply at him. "We will?" she said.

"Why not?" he said with a shrug. "If we're gonna have a last hurrah, might as well make it a good one."

"But, Ken," she whispered. "It's $453."

"With the hotel tax and the late booking fee it will actually be pretty close to five hundred," the clerk felt obligated to point out.

"Hon, maybe we should look around a little first," Meghan said.

"We'll take it," Ken said, pulling his Visa card from his wallet and handing it to the clerk.

"Okay," she said with a smile. She took the card and set it down next to her keyboard.

"It's okay, hon," Ken said to Meghan. "I had an overtime flight this week, remember? That will cover this little vacation. Well ... most of it anyway."

This seemed to make Meghan feel a little better. "Okay," she said. "If you insist."

"I insist," Ken assured her.

"All right then," the clerk said brightly. "Let's get you two checked in. Could I see your identification, please?"

Fifteen minutes later, the ritual of check-in was complete and they were using their keycard to open the door of the mini-suite they'd been assigned on the fifteenth floor of the east tower.

"Nice," Meghan said with a nod as they entered.

"Yeah," Ken said, looking around. "Not bad at all."

The mini-suite was not the nicest or the largest hotel room they had ever stayed in as a married couple, but it was definitely on the top five list. The main room contained a canopied king-size bed, a large, soft-looking couch, and three reclining easy chairs. There was a large-screen plasma television on the wall. Across from the bed were a round glass dining room table and four chairs. Next to this was a bar—empty at the moment, of course, the booze would have to be ordered from room service. In an adjacent room attached to the main room was a large bathroom with two sinks, a huge glass-enclosed shower, and a large Roman-style Jacuzzi tub with ornate brass fixtures. Only the view left a little to be desired. They were in a southward facing room so instead of looking at Lake Tahoe they were looking at the strip and the traffic far below.

"I don't know if it's worth no five hundred dollars," Ken said, paraphrasing from Pulp Fiction a bit, "but it's a pretty fuckin' good room."

Meghan giggled as she threw her bag on the bed. "I need to call Mrs. McAdams," she said, ignoring the room phone and pulling out her cell.