She thumped at the blood vessel on the inside of his arm and inserted the needle, loosening the rubber tubing she’d cinched around his biceps. They both watched as she filled three vials with his blood, then she had him fold his arm back against a cotton ball.

She got a light blue hospital gown from a drawer and handed it to him. “You’ll need to put this on,” she said.

He had a leg crossed on his knee and was examining a mole on his calf, comparing it to the stage-four mole on the skin-cancer chart hanging on the wall, when Dan walked in, apologizing for the wait.

For the next half hour they talked about their inability to afford the homes they wanted, the sorry rise of evangelical right-wingers and how video games were turning out a generation of surly clerks, while Dan listened to his heart, looked in his ears, eyes and throat, pushed and prodded his abdomen, checked his reflexes, finally pricking him here and there with a pin and asking if he could feel it. Or that’s how it came to be lumped together in his memory, as a single blunted and humiliating episode, but about a hundred times easier than telling a man and woman that the child they’d loved and raised was now lost to them.

He then sat on the end of the examination table, watching Dan at the sink in the corner. He made a fist with his left hand and the grip seemed improved. His arm just tingled, and his legs weren’t cramping anymore.

“Why don’t you put your pants and boots on and we’ll see what your heart’s got to say.” Dan was drying his hands.

“Not my shirt?”

“You’d just have to take it off again.”

He followed Dan to a room at the end of the hallway where a young, pale nurse stuck electrodes on his bare chest and guided him onto a treadmill. “It goes easy like this if you don’t have much hair on your chest,” she said, her voice sounding more like chirping than speech.

Dan stood at the head of the machine, studying the readout while they worked him into a trot and faster still, until he hardly had enough air to shout that he ought to be allowed to quit.

Dan tore the printout evenly away from the machine, folding it back upon itself as he started for the door. “Come on down to the office when you’ve got your breath.”

Crane stood crosswise on the inclined tread, gripping the handrail, red-faced and gasping, and the nurse helped him off onto the tiled floor where he stood leaning into her. She was strong for her size.

He sat across the desk from Dan, still overheated, only half-listening to the telephone conversation Dan was having with a doctor at the Billings Clinic. He pulled off his right boot and sock, and when Dan hung up, writing something on a notepad, not saying anything at all, Crane said, “My foot’s blistered.” He moved the pad of a thumb over the blister forming on the ball behind his big toe.

Dan held a slip of paper pinched up in front of him, both forearms resting on the desktop. “I should’ve told you to wear tennis shoes.”

“It’s not my heart, is it?”

“No, your heart’s just fine.” He leaned forward in his chair, and Crane took the slip of notepaper he offered. “Bill McCarthy’s a good guy,” he said. “He’s up in Billings but well worth the drive.”

Crane nodded, folding the paper and slipping it behind the bills in his wallet. He saw the appointment was scheduled for one-thirty in the afternoon, so he wouldn’t have to wake in the dark to get there in time. He hated waking up at night. “Should I wear tennis shoes?”

“No, you’re done with that. McCarthy’s a neurologist.”

Crane nodded again, pulling his boot back on.

“This doesn’t have to be what you think it is,” Dan said.

Crane stood out of the chair. He put his hat on, squaring it. “You don’t know what I’m thinking. You’re not that kind of doctor.”

“But I know you never thought it was your heart.”

He didn’t sleep well that night, or the next, or any of the nights before he told Jean he had to escort a prisoner to Billings and drove by himself to the clinic.

That had been a week ago, and this afternoon he was standing on the screened-in porch off the east end of the house, watching Jean work in her garden. He was on the phone. First it’d been McCarthy’s nurse, but now it was the doctor.

“There’re a few more tests I’d like you to consider.”

McCarthy’s voice sounded farther away than Montana, as if he were calling from somewhere overseas, and Crane wanted to ask, “Did I flunk the others?” or something smart-ass like that, but he hadn’t been able to finish his cereal that morning, his left hand wobbling so much he couldn’t keep the spoon level. He asked, “Is there a problem with the tests we already did?”

“No, Mr. Carlson, the other tests were conclusive.”

“You can call me Crane.”

“Then how about Monday, Crane?”

Jean was dragging a cardboard box behind her, filling it with weeds. When it got too heavy to drag she’d empty it into the wheelbarrow.

“If you have something to tell me I’d rather hear it now.”

“I’d prefer to discuss this in person, Crane.”

“I’m not coming back up there.”

There was a pause on the line, the sound of papers being shuffled. Jean scooted a foam pad ahead of her in the row, kneeled on it and pulled the sodden box along. The bottom was stained dark and looked about ready to tear.

“Your electromyogram indicates certain abnormalities, and along with the other-”

“It’s Lou Gehrig’s, isn’t it?” He moved the phone to his other ear, watching Jean staring up at the sun, checking the advancement of the afternoon. It seemed clear to him how alone she must feel, how little he’d done to fill any part of her life.

“Yes, it is. It’s ALS.”

He sat back against the edge of the wrought-iron table, heard its legs scrape on the redwood and then catch, holding his weight. “Well, goddamn.”

“I’m very sorry, but I think it’s important for you to come in and-”

“I don’t suppose you’ve got a cure now?”

“What I’d like to talk about are your treatment options, Crane. We need to set up a schedule to monitor the possible progressions I believe you can expect.”

Again, the shuffling of papers.

“What I can expect is to lose more control of what muscles I’ve got, until a year or two from now when I’ll die choking on my own spit.”

“That isn’t exactly how I’d choose to characterize it.”

“It’s what killed my granddad.”

At the funeral for the Tylerson boy he’d sat in a back pew, and when Nancy came in, walking very straight with her hands forming fists at her sides, she’d stopped at the end of the row, staring directly at him. Her mouth hung open slightly, like she might be about to speak, or else just didn’t care about closing it anymore, and even though it had only been a little more than a week since he’d seen her, she appeared older, like she wasn’t there at all and had sent her mother instead.

“I’m not finding that in your medical history.”

“I didn’t put it down.”

“There’s a great deal that’s changed, Mr. Carlson. With nasal ventilation, patients can now expect-”

“The same thing they always could.” He hung up, set the phone on the table and pushed through the screen door, standing on the apron of gravel below the stoop. He couldn’t remember if he’d intended to go any farther, but at least he was away from the phone.

“Who was that?” Jean called.

“Work,” he said.

“I thought you were taking a long weekend.”

“I am. Starla was just checking in.” His sunglasses were resting on the top of his head, and he pulled them off, cleaned the lenses with his handkerchief and put them on. The sky fell a deeper blue. “You want to go for a drive?”

She stabbed her gardening trowel into a hump of dirt and stood. “I can’t. I need to study for my exam.” She placed her hands on her hips, pushing them around in a tight circle. She was wearing flowered gloves.