“I’ve raised four children, and I stayed home with all of them. I know how to take care of a sick child.”

I swallowed a sharp retort, resenting the insinuation that I was a lesser mother than her because I worked. I tried hard to be grateful for my mother-in-law. She was a wonderful grandma to Josh, and she and Nate were very close. I didn’t understand why she didn’t like me, although I suspected she was unhappy Nate and my relationship had moved so fast.

“Sure, of course. Sorry, um…”

Julia, a nurse practitioner I’d become friends with, tapped me on the shoulder. “Sorry!” she whispered when she saw I was on the phone. She held a cup of black coffee out to me. “Your four o’clock is in room four.”

Thank you! I mouthed. “Sorry, Moira, I’ve gotta run. Tell Josh I love him.”

I grabbed the coffee and swallowed a giant gulp before hurrying to the exam room. I scanned the patient’s chart as I walked. She was a new patient. Fifty-four years old. Normal temperature. Slightly elevated BP. I rapped gently on the exam room door and entered.

“Mrs. Jones?”

“Yes.” Alice Jones was small and frail. Her pale hair was threaded with gray and tied into a messy ponytail. Spiderweb wrinkles framed the corners of brown eyes clouded with pain. Her clothes were threadbare, a faded sweatshirt over ripped jeans, scuffed canvas tennis shoes with no socks.

Her husband, or who I assumed was her husband, sat next to her, a short, burly-chested man with shiny red cheeks, oily dark-gray hair, and a pair of round glasses on a bulbous nose.

“Her back’s hurting,” he said, his voice too loud in the small space. “It’s been going on a long time now. It’s from all that damned gardening.”

I sat at my desk and turned to Alice. “I’m so sorry to hear that. I like gardening too. I have a whole freezer of vegetables I grew this summer. It’s pretty tough on our back and knees, though, isn’t it?”

I opened Alice’s patient file on my computer and typed notes as her husband explained her symptoms.

“I need to examine you now, Alice. Can you show me where the pain is?”

Alice struggled to stand, her husband holding her elbow firmly. She bent forward at the hips and touched a hand to her lower back.

“Sometimes my legs go a little numb,” she whispered.

I felt a heavy tug of pity in my stomach, the kind you’d feel for an injured bird. I examined her spine, assessed her ability to sit, stand, and walk. There was no redness or obvious swelling. The erector spinae muscles were smooth and strong, her reflexes normal. She wasn’t moving with enough pain to indicate a tear in the disc or enough restriction to show sciatica. But the numbness concerned me.