Look on the Bright Side

Excerpt. © Reprinted by permission. All rights reserved.

ONE

Lark

The sobbing has to stop, Dr. Smith."

Larkby Christina Smith, MD (at least for now), gulped and looked at the head of Oncology at Hyannis Hospital. She wiped her eyes with one of the tissues he'd passed across the desk. Outside, the steady May rain beat against the windows.

"I know," Lark whispered, then cleared her throat. "I'm sorry." There. Her voice sounded slightly less pathetic.

Here in his office, Dr. Hanks (no relation) doled out bad news on a daily basis. Usually to his patients, but today, Lark suspected, to her. The good doctor's voice was firm but gentle, his eyes kind. "The thing is, Lark, it doesn't get easier. Not at all. Oncology isn't for everyone."

First name, not Dr. Smith. That didn't bode well.

"I know you felt close to the patient," Dr. Hanks added.

Lark tried to stifle a sob, failed, and put a hand over her eyes. "It's just . . . you're right. I did. Very close." She swallowed another sob, but traitorous tears still leaked out of her eyes.

Three hours earlier, Lark's favorite patient, Charles Engels, had died after an eight-month battle with pancreatic cancer. And yes, she may have (she had) let emotions get in the way. How could she not? Charlie, as he insisted she call him, had been so wonderful, so funny and kind and positive. He'd been only sixty-four . . . same age as her dad. His wife had been at his side the past three horrible days as Charlie faded in and out of consciousness. On the last day, Mrs. Engels (Patty) had climbed into bed with him, and even though he was barely alive, Charlie had put his arm around her. Their three sons had all been there, crying softly, and the grandkids had visited the day before. Lark had been present for Charlie's last, labored breath, and when Mrs. Engels let out a wail, well . . . so had Lark. She hadn't meant to. It just . . . slipped out.

"Dr. Smith. Get a grip." Dr. Hanks folded his hands in front of him and looked at her firmly.

"Sorry," she said, blowing her nose. God. At thirty-three, she should be in better control of her feelings.

"It's one thing to be sympathetic. It's another for the widow to be comforting you, Lark."

She winced at that. "They, um . . . they felt like family. Charlie . . . that is, the patient told me he wished I was his daughter." She stifled another sob.

"But you're not." Dr. Hanks's voice was a little harder. "And while I commend the commitment you put into your work, it was their loss, not yours."

"Fair point." She'd miss Charlie. He was so sunny, even when he was in pain, someone she really looked forward to seeing every chance she got. Even after her long shifts, she'd stop by his room if he'd been admitted, chatting with him, holding his hand, even singing to him one night.

Dr. Hanks sighed. "We can't have you falling apart every time a patient dies. This is Oncology. We lose patients. We have to make friends with death, at least on some level."

Lark nodded and blew her nose.

"I'm going to transfer you to the ER," Dr. Hanks said, and Lark jolted.

"No! Please, Dr. Hanks! I'll get my shit together. I promise."

Dr. Hanks leaned back in his chair and squinted at her. "We're about to admit a thirty-nine-year-old woman for stage four breast cancer, metastatic to liver and brain, for palliative chemo." He looked at Lark, waiting.

Lark tried to hold her face still. Felt her lips wobbling, and tried not to blink so the tears wouldn't fall. Didn't even breathe. Nodded in what she hoped was a clinical yet compassionate and professional manner. "I see." Her voice was tight, but not choked. Well done, Lark.

"Three kids. Ten, six, and three. Found out she had cancer when she couldn't nurse the last baby."

"Oh, God! That's so unfair!" So much for restraint, Lark thought as she shook with sobs. Her niece was three. What if Imogen lost Addie? What if Lark lost Addie, her identical twin?

"Again, the sobbing," said Dr. Hanks. "I'll call the head of the Emergency Department and make this official. It'll be good for you. Fix 'em up and ship 'em out, no chance to get too attached."

"Wait. Wait. What if I, um, improve?" She took a breath and tried to sound more convincing. "I was meant for this field, Dr. Hanks. You know my history. Give me a chance to prove myself."

Dr. Hanks sighed in that can we please end this conversation way. "I won't rule it out. We can talk about it in a couple months, how's that? Take a couple days off, and best of luck."

Lark’s fellow residents hugged her, told her she had a good heart, was a great doctor, all that. It helped, a little. But everyone was aware she was leaving because she couldn’t hack it. And hacking cancer was supposed to have been her life’s purpose.

The second she got outside of the hospital, she did what she always did in times of crisis-called her twin.

"What happened?" Addison asked before she said a word. This was typical for them, not always needing words to communicate.

"I got kicked out of Oncology and was transferred to the Emergency Department," she said.

"Ouch. Demoted."

Lark winced at the word, which was all too accurate. "Yeah." Not that emergency medicine was for stupid people, of course. But being an oncologist took years more training. You spent more time with patients, got to know them, helped them through the worst time of their lives, and hopefully cured them. Plus, the whole life's-calling part. Her plan had been to work here on the Cape as an oncologist, admitting patients to Dana-Farber Cancer Institute in Boston as needed, just ninety minutes away. She'd imagined being absolutely adored by her patients for her intelligence, her compassion and commitment. Her, um, grace under pressure.

Her eyes filled again.

"You were crying too much, weren't you?" Addie asked.

"Mm-hmm." Weeping had always kind of been her thing. Addie had gotten the tough genes when their egg had split thirty-three years ago. She'd had Imogen after twenty-seven hours of back labor and not a single drop of painkiller. Lark knew this, since she'd been on one side of the bed, Addie's wife, Nicole, on the other. It had been one of the best days of her life. Lots of tears then, too, but all so happy.

But if Addie had gotten the tough genes, Lark got the smart genes. Like their older sister, Harlow, Lark had been valedictorian at Nauset Regional High School. She'd gone to Boston University, then Tufts for med school, graduating in the top 2 percent of her class.

"Well," Addison said, "this doesn't mean anything." Lark heard her sister clicking on a keyboard. "You can go back to Oncology. I just checked."

"My chances just threw themselves off a cliff, though."

"Try not to overthink it, Larkby," she said, one of the few who used her full name. "The ER will toughen you up. You'll see all sorts of amputations and crushed limbs and gunshot wounds, right?"

"More like drug overdoses and tick bites."

"Well, it doesn't matter. You're amazing. You're already an MD. This will all work out in the end."

"Thanks, Addie." Lark smiled a little. Addie's confidence in her was always a boost.

"Gotta go. Esme's bus is due any second." Esme was her older daughter, the bio-baby of her wife. Same sperm donor, so the girls were half sisters.

"Send me a picture of the girls, okay? Love you." She ended the call, waited five seconds and smiled as the picture came through. Addie always had fresh photos of the girls, being one of those moms who posted on Instagram and TikTok at least three times a day. It was the only reason Lark still had social media accounts-to see her nieces. She couldn't remember the last time she'd posted herself. At least seven years ago, she knew that.

The photo from Addie was of three-year-old Imogen, dressed all in beige, her blond hair shining. She had the same green eyes as Lark and Addie, the same long blond lashes. Lark's heart gave a happy, hard squeeze. She could spend at least some of her enforced time off with her nieces, and that was never a bad thing.

Her phone buzzed again-the hospital, asking her to call in. She probably needed to do some paperwork, because what was medicine without paperwork? Obediently, she called the number.

"Hi, Vanessa, it's Lark Smith," she said to the receptionist, recognizing her voice. Saying Dr. Smith still felt weird. She'd been an official doctor for only two years.

"Hey, hon. You have an urgent message from Dr. Santini," Vanessa said. "He needs you to return his call as soon as possible."

"Dr. Santini? The surgeon Santini?" she asked, faintly alarmed. "Maybe you have the wrong number, Vanessa?"

"I'm just the messenger, honey. He was clear."

"Huh. Okay. He didn't say what it was about?"

"He just growled your name and said you needed to call him."

"And it was definitely Lark Smith? Not Odell Smith?" Please, God, let it be Odell.

"It was you, kid. Sorry." Vanessa recited the number, which Lark typed into her phone.

"Thanks, Vanessa. Tell your handsome hubby I said hello."

"I will, honey, I will." Lark could hear the smile in Vanessa's voice.

Dr. Santini. It was probably a mistake. The man was loathed, feared and admired, the last for his abilities in the OR. Outside of that, he was referred to as Dr. Satan. She couldn't imagine why he'd need a lowly (now somewhat disgraced) resident. She'd only met him during the painful weeks of her surgical rotation, during which she tried to blend in with the walls. Lark didn't even know his first name. Though he was probably only around forty, he was definitely old school, the kind of doctor who used terror, intimidation and ridicule to educate. As she well knew.

Happily, he worked only occasionally at Hyannis Hospital, swooping in from the great institutions of Mass General Brigham, Dana-Farber, Beth Israel. On top of being truly gifted, he had also invented a device that kept organs oxygenated during transport, making it much more likely for them to be successfully transplanted. According to rumor, it had made him fabulously wealthy. Lark had seen him getting out of a Maserati one day in the parking lot but had ducked down behind an SUV so as not to attract attention. No one wanted attention from Dr. Santini except his patients.

During her surgical rotation, she'd gotten some, unfortunately. The godlike Santini had agreed to do rounds with them, the lowly residents! It was terrifying and thrilling. "Santini! Educating us! Can you believe it?" Also: "Stay on your toes. Don't speak unless spoken to. Don't make an ass of yourself. He eats people like us for a bedtime snack."

Lark had been the snack. During rounds that unhappy day, he'd barked out, "What diagnosis should be considered for anal fissures that are not at six or twelve o'clock?" No reason. Just whimsy. Just a sort of gotcha pop quiz.

At the words anal fissures, one of her classmates snickered. Unfortunately, he'd been standing right next to Lark, who went red with terror as Dr. Santini turned toward them. His eyes settled on her, and she swallowed.

"You think this is funny?" he snarled. "You think someone's pain is funny, Dr. . . ." He looked at her jacket. "Smith?"

"No, sir," she said in a near whisper. She didn't do well with angry people, but neither was she about to rat on Tomas. "Not at all."

"Answer the question, then."

By then, she'd forgotten the question. To be fair, she'd been awake for thirty-two hours straight, and also fear tended to make her mind go blank. "Can you repeat it, please?" Her voice shook. Her fellow residents oozed away from her, including Tomas. No one made eye contact.

"No! Do you think I have time to repeat it? Someone else, answer."

"Crohn's disease," said Lacey, a Nigerian student with a photographic memory. She cut Lark an apologetic look.

"Crohn's disease, Dr. Smith! Anal fissures anywhere but twelve and six o'clock indicate Crohn's or another underlying disease. Dr. Smith, do us a favor and name at least three other diseases that could indicate anal fissures at anywhere but twelve and six o'clock!"

He sure liked saying anal fissures. "Ulcerative colitis and childbirth?" she said meekly.

He glared. "Two more, and try to speak like a doctor and not a scared sixth grader."

"Colon cancer and . . . um . . . HIV."

He turned and strode off to the next patient, the five residents following like a swarm of fearful bees. Blessedly, that had been the only time he'd spoken to her, since she was a peasant who didn't want to become a surgeon.

Why he would want her to call him now, she had no idea. She dialed the number, which went right to voice mail. "Dr. Santini. Leave a message."

"Um, hi. This is Lark Smith. Dr. Smith? Um . . . you asked me to call you, I think. So here I am. Okay. Well. Make it a great day!"

Shit. She should've planned what to say.

Maybe he was calling because he'd heard Charlie Engels had died. Two years ago, he'd done a Whipple procedure on Charlie Engels, in fact, which had certainly extended Charlie's life. It was one of the most complicated surgeries there was, removing the head of the pancreas, the bile duct, the gallbladder and part of the small intestine, then reconnecting everything. Postoperative complications were common. But Dr. Santini, despite having the personality of a feral boar, had done a beautiful job, and Charlie healed without incident.

But calling her because he thought she'd be sad? That didn't seem like him.

A second later, her phone buzzed with a text.

Meet me at 6:30 at the Naked Oyster on Main Street.

She frowned. I think you have the wrong person, she typed.

I don't. Be on time. Obviously, I'll pay.

Gathering her nerve, she typed, Can I ask why you want to see me?

No answer. No three dots, either. God didn't have to answer a lowly resident.

It was quarter to six now. Wellfleet, where she lived, was forty-five minutes away, so going home to change wasn't an option. Today, she wore the typical, sensible-professional garb of a hospital resident-a knee-length black skirt, white oxford and Naturalizer flats Addie described as "shoes that would make a nun weep with boredom." But Addie didn't have to spend twelve hours a day or more on her feet. Hospital policy had her wear her hair up, keep her earrings small and cover the one tattoo she had. In other words, she looked like she was about to knock on someone's door to talk about the Church of Jesus Christ of Latter-day Saints.