It began as a minor pimple-like irritation. He caught himself idly pinching the earlobe between thumb and forefinger, sitting at his desk, at home in front of the TV, in bed, while he was walking the dog, troubling the spot like, well, like a dog gnawing an open sore. In the conference room the pimple finally popped, making a gratifying fizzy sound as the woman from Marketing in her silk blouse and chalk stripe skirt delivered a PowerPoint presentation. She sure knew her PowerPoint! The lights were dimmed, and seven or eight people sat around the broad polished table, politely stifling yawns as they doodled on their Xeroxed handouts. She was talking about mid-range cost factors, and he wished he could see her calves, which he’d noticed earlier were propped up in a pleasantly muscular way by her spikey heels. The sound, occurring so close to the eardrum, seemed jarring, a miniature explosion, and he checked to see if anyone had heard. No one was looking at him but maybe they were just averting their eyes out of embarrassment. Warm colorless liquid trickled down his thumb and he figured that was the end of it.

There was a window in the room, and he could see the trees outside bowing in the wind, leaves flying from them as though suctioned by a giant vacuum, the vacuum of winter swallowing autumn. The November sky at ten in the morning was as black as a blackboard, which was technically more greenish-gray with white swirls of smeared-up words on it. Sitting there he recalled from childhood the mineral smell of chalk, the way the sticks crumbled when pressed too hard, how the powder clung to your hands, and it saddened him that today’s students would never experience such things. He remembered walking to the front of the classroom and writing his name in beginner’s script on the board. This was what happened when you misbehaved: you were made to write your name in an unoccupied corner of the blackboard and place a checkmark next to it for every successive sin. For the boys these became thin white trophies of their transgressions. Modern kids would never feel the satisfaction of clapping erasers together to create chalky clouds, the ghosts of erased sentences lifting into the air. Now it was all whiteboards and dry-erase, all very clinical.

The woman from Marketing’s name was Suzanne. Her skirt, he noticed, matched the sky. Her scarf contained the colors of both skirt and blouse, as well as an additional accent shade, suggesting the whole ensemble had been fitted together like a puzzle. He wondered if Suzanne had always been so well-coordinated or if there had come a point in her life, maybe a shiftless period after college, when she made a conscious decision to get her shit together. Single, fifteen pounds overweight, working as an executive assistant (read: secretary), burdened by student loans, maybe she’d had an epiphany, maybe saw a startling image of her life stretching before her. Cats. Church committees. Slacks with elastic waistbands. She joined a gym, updated her resume, grew a bit more aggressive on the dating front. Or maybe it just comforted him to believe that people were capable of transformations, like the women on infomercials whose lives were forever altered by abdominal rollers and dance workouts.

After a couple days the irritation crusted over. Every now and then he folded back his ear to examine the scab in the mirror, usually at home but also in the car’s rearview or in the restroom at work if no one else was around. The sore was coffee colored, larger now. During the workday he picked at the scab and then glanced around guiltily to see if anyone was watching.

Maybe you should go see a doctor. The way his wife said it made it sound like a suggestion—a question, really—but the issue was not up for debate. She’d become annoyed by his constant fingering of the earlobe and wanted him to seek out medical attention, and not just randomly but from her doctor. She was possessive of this doctor, as though she’d financed the woman’s schooling and now kept her on retainer. The ear thing seemed so minor, unworthy of a healer’s time. He didn’t want to go to her doctor. He was getting worked up about it, his thoughts becoming italicized. At work the next day he spent a half hour trying to schedule an appointment online with someone else: set up a user account, establish a password, indicate your ailment from the drop-down menu, specify your insurance plan, choose a provider. His affliction wasn’t on the drop-down menu, he didn’t have a specific physician in mind, but the website took an inflexible stance. It folded its arms like a bouncer outside a club. You couldn’t just leave these items blank.

He didn’t like using his work phone for personal matters, where a colleague might overhear, but his struggle with the website had ended in a stalemate so finally he called his wife’s doctor, the dial of shameful surrender. He called her office, anyway, and spoke to a girl at the front desk. Jesus, was he so old he was calling them girls now? He sounded like a coffee-breathing uncle with nostril hairs that whistled with every breath.

He’d never actually met the doctor before. His wife and the doctor were close in age—contemporaries, you might say—and the way his wife described the visits made them sound like gab sessions, two girlfriends catching up over mani-pedis. The doctor thought his wife might be stressed and prescribed some Celexa and some Luvox. His wife didn’t reveal to him the causes of her anxiety. He suspected his wife had shared with the doctor intimate details of their love life. He knew they’d discussed his wife’s flagging libido. Was he to blame for this tugging of the reins on the sexual front, the slowing to an amble or, if truth be told, a full stop? Nothing about him had changed. But, well, okay, maybe that was part of the problem.

The doctor had examined his wife and would now examine him. She was an impartial third party, a judge, a referee. He had requested a physical, urinalysis, blood tests, the works. Years had passed since his last exam and he feared something serious had taken hold in the interim, like dry rot or termites in an old house. Maybe the scabrous sore on his ear had triggered some infection even now pinballing around his system.

No one looked well in the waiting room, not even the people who’d come for well-visits. They looked peaked, about to barf. The waiting area was bisected into separate sub-areas for the well and the unwell. For some reason everyone—ailing and healthy alike—was wearing puffy vests. Now you received an electronic tablet at the check-in window instead of a clipboard. You swiped your own credit card. It was as though the office girls were handing you their obsolescence.

He went back to his seat and began thinking about all the sickly puffy-jacketed people who’d handled these iPads. Nearby, two young boys were jostling each other, coughing deep bronchial open-mouthed unchecked coughs, greenish mucous stalactites dangling from their nostrils. “I would shoot you in the face,” one boy told the other.

“I would shoot you in the back of the head, execution-style.”

“I would bury you alive in cement.”

“I would knife you in the eyeball.”

“I’m going to kill both of you if you don’t shut up,” their father said, busily prodding his personal handheld device with a stylus. He didn’t have a puffy vest, though both kids did. He was wearing a knee-length coat of a rich curry-combed material like something you might enjoy petting, cuffed herringbone slacks, shiny whole-cut Oxfords, a shimmering German engineered wristwatch that probably matched his luxury sedan. Even his dress socks screamed money. He continued in his matter-of-fact tone: “I’m going to dismember you and toss the body parts in a meat grinder and feed the ground-up meat to the neighborhood dogs.” The kids were not listening.

On a flat-screen mounted high up on the wall, out of reach of the infected, a man in a commercial was talking about some new disease that caused people to quiver and sweat a lot and smile inappropriately. If you have these symptoms, ask your doctor about Quinexa.

Quinexa, Quinexa, he thought, sitting upon the tissue-papered exam table, legs dangling, in a paper robe and boxers, after gaining entry to the warren of hallways and rooms where the real business of treatment took place. Everything the patients came into contact with was disposable. “Which way does it go?” he had asked, unfolding the robe when the nurse handed it to him.

“Doesn’t matter,” she said. Well, that depends. Finally he decided to tie it in front, as this seemed the more appropriate setting for a drawstring. But here he was, second-guessing his decision, quivering, sweating profusely, in danger of smiling inappropriately. Quinexa! He’d decided after some hesitation to remove his socks and was now examining the dress-sock induced bald patches above his ankles. Should he ask the doctor about them? Smooth and shiny, they reminded him of how he and the other grade-school kids would dispense a dollop of Elmer’s glue onto the backs of their hands, spreading it around, allowing the glue to dry, and then peeling it off like a layer of dead skin. Afterward their hands had appeared rejuvenated, and they kept the dead Elmer’s snakeskins in their pencil boxes as mementos. When they were discovered abusing their glue, they were made to write their names on the board or, for recidivists, add a checkmark.

He did not find the doctor unassailably attractive. She wasn’t like Suzanne from Marketing, so well-constructed, like a German auto, that it was impossible to imagine her ever malfunctioning. She had pleasant green eyes and freckles, dark hair tied back in a ponytail, like one of those shy girls in high school who grew up on an acreage with a couple of horses and a small flock of chickens, someone who played the clarinet and lettered in cross country. You didn’t think she’d become a doctor, not because she was incapable but simply because you didn’t consider her one way or the other. The doctor was wearing New Balance running shoes and a white lab coat, and she smelled of lavender soap.

And then he’s somewhere else: squinting at the number on a mailbox, rechecking the scrap of paper in his hand before creeping up the long gravel drive. He parks and turns the car off, engine ticking, beside a garage with peeling paint. Half-wild cats creep around the side of the building. A cloud of chaff in the air from a combine harvesting a nearby field. Walking toward the house along a worn path. Hens in their enclosure, pecking at bugs or feed or tossed-out watermelon rinds, whatever it is they peck at, heads jerking mechanically. He steps onto the porch, knocks at the screen door. Hands in his pockets while he waits, the wind cool on the back of his neck. A dog inside barking once or twice, deep and baying, then silent, an old arthritic animal turning in a circle before repositioning itself closer to the furnace vent. She comes to the door, hair still wet, in a flannel shirt and jeans and a pair of suede boots, smiling broadly, her teeth very white. As they walk toward the car her father steps out onto the porch, dark-haired but with a white winter beard coming in, holding a cup of coffee as he leans against a porch post, his other hand in the pocket of his hooded sweatshirt. His daughter turns and waves, and he nods.

Strolling through an orchard. The smell of rotting fallen apples and decaying leaves. Drinking cider from tin cups while sitting with strangers on long benches in a warm room full of golden light. During the hayrack ride he takes her hand and she lets her head fall against his shoulder. The country roads are dark, he’s watching for deer, but he looks over at her when she says she’d like to study medicine. Something playing on the cassette deck low, something from Nebraska, even though he never listened to Bruce Springsteen back then. It seems appropriate for this scene, the film version, the way he’d revise his memories if he could. He’s not sure what he wants to study. His guidance counselor tells everyone to join the armed forces, even the smart kids bound for East Coast schools.

I might do business, he says finally, feeling the need to respond. He feels like something has flopped from his mouth and is wiggling on the console between them, something that needs clubbed over the head, euthanized.

You need to stop touching your ear, he hears her say, returning to the exam room, the antiseptic white floor cold to the touch, the snowy light drifting from the ceiling, the sink in the corner, the shelf above it, glass jars full of cotton balls and tongue depressors. Framed pictures on the walls of the sort found in Hilton hotels, folk art and architectural line drawings.

Just let it heal. There’s something about her admonitory tone, a smile hidden in it, playfulness. All right, so he can see the attraction. Her fingers skitter over his chest and spine, prelude to the cold stethoscope. She listens to his heart and lungs. Are you a runner?

He’s surprised she doesn’t know this. His wife hasn’t told her about the odd compulsion? Or maybe she has, but now the doctor is feigning ignorance. She hasn’t mentioned his wife, hasn’t asked how she’s doing. Is this some principle of doctor-patient confidentiality? Or is the relationship between his wife and the doctor somehow magnified in his wife’s mind? Yep, he says, what about you? He points at her sneakers. A little, she shrugs. I’ve got some plantar fasciitis issues. It’s something they share now, the two of them, just as his wife and the doctor share the details of his love life. The doctor takes in these facts and compartmentalizes them, like the waiting room where the sick are placed on one side, the healthy on the other.

He stands at the finish line, cheering the doctor’s final steps. Sweat has curled the wayward strands of hair along her brow, and she looks exhausted but happy, her face flushed. He places the Mylar blanket over her shoulders and hands her a bottle of water, the cap already loosened for her. They kiss on the way to the car, her lips salty, sweat soaking the small of her back. Sitting there on the exam table in his robe and boxers, he tells her about his knee, the occasional soreness after his runs, and she’s massaging the bumps and divots around his kneecap, questioning, nodding, listening, probing. She has moved on from the subject of the earlobe, nothing an antibiotic cream can’t take care of, a minor thing, embarrassing to give it more attention than it deserves. She has moved on to the subject of running, this common ground between them. This is magnetism, her ability to find the thing that draws patients nearer. If the ear were truly a problem, there would’ve been more discussion of it.

What’s your longest race? she says.

I’ve run a few marathons.

Really, she says. It’s not a question, and he’s not sure how to respond. You can drop your shorts now, she says. Then she’s talking about the half-marathons she’s run, how she’s not sure she’d ready to dedicate herself to a marathon, the training involved. He unties the string at his waist and the robe falls open. She pushes off with her sneakers and her wheeled stool slides backwards. She’s giving him space, and he bends, drawing his boxers down to his ankles. He’s standing, she’s at the level of his midsection, she says she can’t recommend the new line of New Balance trainers highly enough. Mmm, he says, a garbled sound. He prefers Mizunos, but how do you disagree with someone who’s glad-handing your genitals? He knows she married someone older, and he’s picturing some version of her father, which is weird, because his vision of her father—the worn bearded face, the thin dark hair and sweatshirt and Levis, standing on his porch, coffee mug in hand—is also a mirage. He knows her husband brought a couple kids to the marriage from a previous relationship but that she has none of her own.

These things his wife came home and told him after her gab sessions with the doctor. He wonders if the doctor is capable of bearing children. He finds he cannot meet her eyes. She wears a plain wedding band, similar to a man’s, and it brushes his scrotum, cold. He might be smiling inappropriately. What about Quinexa? he asks.

I’m sorry?

He wonders how many hernia checks her wedding ring has been party to. Is the procedure really so pedestrian for the doctor, or has she merely become adept at concealing her revulsion at a scabby puss-filled ear or random genitalia? She peels off her gloves, works the foot pedal on the garbage can, tosses the gloves in as he’s pulling up his underpants. There’s a counter by the door, and she stands there writing out a prescription for the antibiotic cream. The nurse will be in to take some blood, she says. Her smile is like a baseball throw, something she’s practiced so many times it’s automatic. She’s a shapeless figure departing in her white coat, and he’s alone in the room.

He removes the robe, tosses it on the exam table, pulls his pants on, cinches his belt. He tries to smooth the paper where he’s been sitting. Something about its wrinkled appearance bugs him, something disheveled about it reminds him of all the sickness in this place. There’s a mirror on the far wall, and he’s bothered by his own reflection, corduroyed but shirtless, something emasculating in that, and he struggles into his undershirt, putting it on inside out. He reaches almost subconsciously to massage his earlobe but draws his hand back when he hears a knock at the door, the nurse simultaneously entering. She’s swabbing alcohol on his finger. The finger prick. Filling two vials with his blood.

He spent the weekend with his wife at a B&B in Massachusetts once, a house on a quiet street in an old mill town. This was when they were living briefly on the East Coast. There were three other couples staying in the house that weekend. Four couples arriving at different times, the host showing each couple to its room. They spent some time unpacking, trimming each other’s toenails, reading Rod McKuen love poems, whatever it was people did when they first arrived at B&Bs, making efforts to move about as quietly as possible, feeling like intruders in a stranger’s home. They gradually made their way down to the living room, where the host offered them a drink, and as the eight began drinking, chatting, he and his wife found they were the only ones in the group who had not met online. Worse yet, they were high school sweethearts. It seemed so quaint, so falsely wholesome, and he couldn’t help feeling that the other guests, bonded by their virtual matchmaker, treated them differently, more distantly, after their shameful admission. Though roughly similar in age to the other couples, they found themselves aligned with their host, with her platinum-dyed hair and her clattering bracelets, her home full of doilies and framed needlepoint truisms and tiffany-style lamps, part of a different generation of milkmen and newspaper routes and rotary phones. It was like a sickness apparent on them, a malaria.

In fifth grade the girls in his class disappeared, whisked away for an hour or so, and when they returned they carried small packages under their arms. Try as they might, the boys could not get the girls to reveal where they’d gone or what was in the boxes they promptly hid away. They’d been told not to reveal anything, and they kept their promises. It was the first time he realized there was something truly different about these creatures he shared a classroom with, a feeling, inexpressible, as diffuse as a cloud of chalk dust.

He and the doctor are floating in a canoe on a lake at sunset. The water laps softly against the aluminum boat. The lake is surrounded on all sides by dark trees. Migrating geese form a V in the sky, which is blue, orange, black. He hears a cry and recognizes it as a loon. Apparently he knows about birds. He is wearing a sweater and some crisply pressed khakis. An oil has been applied to his boots that makes them impervious to the elements. Apparently he enjoys shopping from the LL Bean catalog. There’s a danger in thinking our choices don’t matter but there’s also a danger in thinking our lives would’ve been different, better. Regret should be imbibed in small quantities. The doctor, in her white smock and tennis shoes, is holding an oar and staring off into the distance. She’s an expert on all matters of the human body, a generalist.

His ear is still bothering him, crying out to be touched.