“I know your daughter is very upset, but if you can’t quiet her down, do you think you could show some fucking consideration to the rest of us and get off your wide ass and take her outside where we won’t all have to listen to her squall?” asked the receptionist, smiling her plastic, stapled-on smile.

The color drained out of Allie Letterworth’s face, leaving a few hot, red spots glowing in her waxy cheeks. She held her daughter by the wrist. The little girl’s face was a hideous shade of crimson now, and she was pulling to get free, digging her fingernails at Allie’s hand.

“What?” Allie asked. “What did you say?”

“My head!” the receptionist shouted, dropping the smile and tapping furiously at her right temple. “Your kid won’t shut up, and my head is going to explode, and-”

“Fuck you!” shouted Allie Letterworth, coming to her feet, swaying.

“-if you had any consideration for anyone else-”

“Shove it up your ass!”

“-you’d take that shrieking pig of yours by the hair and drag her the fuck out-”

“You dried-up twat!”

“-but oh, no, you just sit there diddling yourself-”

“Come on, Marcy,” said Allie, yanking at her daughter’s wrist.

“No!” said the little girl.

“I said come on!” said her mother, dragging her toward the exit.

At the threshold to the street, Allie Letterworth’s daughter wrenched her wrist free from her mother’s grip. She bolted across the room but caught her feet on the fire truck and crashed onto her hands and knees. The girl began to scream once again, her worst, most piercing screams yet, and rolled onto her side, holding a bloody knee. Her mother paid no mind. She threw down her purse and began to yell at the receptionist, and the receptionist hollered shrilly back. Ig’s horns throbbed with a curiously pleasurable feeling of fullness and weight.

Ig was closer to the girl than anyone, and her mother wasn’t coming to help. He took her wrist to help her to her feet. When he touched her, he knew that her name was Marcia Letterworth and that she had dumped her breakfast into her mother’s lap on purpose that morning, because her mother was making her go to the doctor to have her warts burned off and she didn’t want to go and it was going to hurt and her mother was mean and stupid. Marcia turned her face up toward his. Her eyes, full of tears, were the clear, intense blue of a blowtorch.

“I hate Mommy,” she told Ig. “I want to burn her in her bed with matches. I want to burn her all up gone.”

THE NURSE WHO TOOK Ig’s weight and blood pressure told him her ex-husband was dating a girl who drove a sporty yellow Saab. The nurse knew where she parked and wanted to go over on her lunch break and put a big long scratch in the side with her car keys. She wanted to leave dog shit on the driver’s seat. Ig sat perfectly still on the exam table, his hands balled into fists, and offered no opinion.

When the nurse removed the blood-pressure cuff, her fingers brushed his bare arm, and Ig knew that she had vandalized other people’s cars, many times before: a teacher who’d flunked her for cheating on a test, a friend who had blabbed a secret, her ex-husband’s lawyer, for being her ex-husband’s lawyer. Ig could see her in his head, at the age of twelve, dragging a nail along the side of her father’s black Oldsmobile, gouging an ugly white line that ran the length of his car.

The exam room was too cold, air conditioner blasting, and Ig was trembling from the chill and his nervousness by the time Dr. Renald entered the room. Ig lowered his head to show him the horns. He told the doctor he couldn’t tell what was real and what wasn’t. He said he thought he was having delusions.

“People keep telling me things,” Ig said. “Awful things. Telling me things they want to do, things no one would ever admit to wanting to do. A little girl just told me she wanted to burn her mother up in her bed. Your nurse told me she wants to ruin some poor girl’s car. I’m scared. I don’t know what’s happening to me.”

The doctor studied the horns, worry lines furrowed across his brow. “Those are horns,” he said.

“I know they’re horns.”

Dr. Renald shook his head. “They look inflamed at the points. Do they hurt?”

“Like hell.”

“Ha,” said the doctor. He rubbed a hand across his mouth. “Let me measure them.” He ran the tape around the circumference, at the base, then measured from temple to point and from tip to tip. He scratched some numbers on his prescription pad. He ran his calloused fingertips over them, feeling them, his face attentive, considering, and Ig knew something he didn’t want to know. He knew that Dr. Renald had, a few days before, stood in the dark of his bedroom, peering around a curtain and out his bedroom window, masturbating while he watched his seventeen-year-old daughter’s friends cavorting in the swimming pool.

The doctor stepped back again, his old gray eyes worried. He seemed to be coming to a decision. “You know what I want to do?”

“What?” Ig asked.

“I want to grind up some OxyContin and have a little snort. I promised myself I’d never snort any at work, because I think it makes me stupid, but I don’t know if I can wait six more hours.”

It took Ig a moment before he realized that the doctor was waiting for his thoughts on the matter.

“Can we just talk about these things on my head?” Ig said.

The doctor’s shoulders sank. He turned his face away and let out a slow, seething breath.

“Listen,” Ig said. “Please. I need help. Someone has to help me.”

Dr. Renald reluctantly looked up at him.

Ig said, “I don’t know if this is happening or not. I think I’m going crazy. How come people don’t react more when they see the horns? If I saw someone with horns, I’d piss down my own leg.” Which, in fact, was exactly what he had done, when he first saw himself in the mirror.

“They’re hard to remember,” the doctor said. “As soon as I look away from you, I forget you have them. I don’t know why.”

“But you see them now.”

Renald nodded.

“And you’ve never seen anything like them?”

“Are you sure I can’t have a little sniff of Oxy?” the doctor asked. He brightened. “I’d share. We could get fucked up together.”

Ig shook his head. “Listen, please.”

The doctor made an ugly face but nodded.

“How come you aren’t calling other doctors in here? How come you aren’t taking this more seriously?”

“To be honest,” Renald said, “it’s a little hard to concentrate on your problem. I keep thinking about the pills in my briefcase and this girl my daughter hangs out with. Nancy Hughes. God, I want her ass. I feel sort of sick when I think about it, though. She’s still in braces.”

“Please,” Ig said. “I’m asking for your medical opinion-your help. What do I do?”

“Fucking patients,” the doctor said. “All any of you care about is yourselves.”