If, Then Read online

  If, Then is a work of fiction. Names, characters, places, and incidents either are the products of the author’s imagination or are used fictitiously. Any resemblance to actual persons, living or dead, events, or locales is entirely coincidental.

  Copyright © 2019 by Kate Hope Day

  All rights reserved.

  Published in the United States by Random House, an imprint and division of Penguin Random House LLC, New York.

  RANDOM HOUSE and the HOUSE colophon are registered trademarks of Penguin Random House LLC.

  Hardback ISBN 9780525511229

  Ebook ISBN 9780525511236

  randomhousebooks.com

  Book design by Caroline Cunningham, adapted for ebook

  Cover design: Anna Kochman

  Cover photograph: Gallery Stock

  v5.4

  ep

  Contents

  Cover

  Title Page

  Copyright

  Epigraph

  Part I: The Man in the Woods

  Chapter One

  Chapter Two

  Chapter Three

  Chapter Four

  Chapter Five

  Chapter Six

  Chapter Seven

  Chapter Eight

  Chapter Nine

  Chapter Ten

  Chapter Eleven

  Part II: Counterfactuals

  Chapter Twelve

  Chapter Thirteen

  Chapter Fourteen

  Chapter Fifteen

  Chapter Sixteen

  Chapter Seventeen

  Chapter Eighteen

  Chapter Nineteen

  Chapter Twenty

  Chapter Twenty-one

  Chapter Twenty-two

  Chapter Twenty-three

  Part III: Broken Mountain

  Chapter Twenty-four

  Chapter Twenty-five

  Chapter Twenty-six

  Chapter Twenty-seven

  Chapter Twenty-eight

  Chapter Twenty-nine

  Chapter Thirty

  Chapter Thirty-one

  Chapter Thirty-two

  Chapter Thirty-three

  Chapter Thirty-four

  Chapter Thirty-five

  Dedication

  Acknowledgments

  About the Author

  I believe, and so do you, that things could have been different in countless ways.

  —DAVID LEWIS, COUNTERFACTUALS

  I

  The Man in the Woods

  ONE

  THE EARTH TREMBLES. She tastes metal. That’s how it starts on a moonless Sunday in Clearing, Oregon, in the shadow of the dormant volcano locals call Broken Mountain.

  Just after 10:00 P.M. Ginny stands at the bathroom sink, a toothbrush in one hand and a paperback in the other. She always reads like this, in minutes parceled out from her packed days—in the bathroom after everyone has gone to bed, or parked in her car when she gets to the hospital a little early. The heat whirs in the vent. She considers staying up to read another chapter. Her husband, Mark, is already asleep in the next room.

  Her pager buzzes from the bedroom and she retrieves it from her bedside table. A series of familiar numbers scrolls across the tiny backlit screen. The emergency room. “Damn.”

  She dials the number. “ER,” the nurse answers.

  “This is Dr. McDonnell. I was paged?”

  “Let me get Dr. Pierce.”

  Classical music plays energetically in her ear. She sits down on the edge of the bed. Suddenly she’s tired.

  One of the cats jumps down from the comforter and stalks out the door toward Noah’s bedroom. But Mark doesn’t stir. He’s learned how to sleep through her nighttime pages. His face is naked without his glasses, his curly hair black against the white sheets.

  She turns down the volume on the phone and switches on her lamp. Mark rolls over on his side but doesn’t wake. The music is tinny and faraway in her ear. The floor shakes; there’s a metallic taste in her mouth. Her vision abruptly alters—

  Where Mark was sleeping a woman appears. Her face is so familiar…Edith. Her friend’s hair is always pulled back in a bun at the hospital. Now it fans out in crinkly waves across the pillow. Freckles stipple her shoulders and the tops of her breasts.

  Ginny smells warm skin and damp sheets; she hears her own quickened breath. A swell of desire, uncomfortably strong, rises inside her abdomen. The woman reaches out, as if to stroke Ginny’s hair.

  Then, in an instant, she’s gone. Mark’s back in the bed.

  Ginny rubs her eyes, blinking furiously.

  “Dr. McDonnell—” Brian Pierce’s strident voice comes through the phone. “We’ve got a seventy-five-year-old man with a rigid abdomen, white blood count of 24,000, fever of 101.2, peritoneal signs, and free air on abdominal films. Came into the ER about an hour ago. His name is Robert Kells. Can you come in and take a look?”

  She’s silent for a beat, her mind still anchored to Edith’s lovely face. “Any major medical issues?” she finally musters.

  “A history of liver disease—” There’s the rustle of paperwork. “We’ve admitted him a couple of times for pancreatitis. That’s it.”

  “We need to set up for an ex-lap.” Her brain has come back to life, has switched into the proper gear.

  “I’ll tell the charge nurse. Just get on the road. This guy isn’t going to last long.”

  Ginny follows her usual routine: pulls on scrubs, scrapes her hair into a short ponytail, and rubs lip balm on her lips. She climbs into her Acura SUV and backs out into the deserted cul-de-sac. Her neighbors’ porch lights are off. Behind her house the forest is a dark blank. Rain mists her windshield.

  She drives down the hill and across town, and the mountain recedes in her rearview mirror. She usually likes the ride to the hospital at night—the empty streets, the sealed-in quiet of her car, the gentle tack tack tack of her turn signal as she idles at stoplights. But tonight these things don’t bring her peace.

  She’s disturbed by what she saw. She must have fallen asleep for a second. Or she has a brain tumor. She recalls a list of symptoms from her neurosurgery rotation in residency:

  headaches

  problems with balance

  blurred or double vision

  seeing things that aren’t there…

  She turns into the staff parking lot. The scrubs, the ponytail, the car ride—they haven’t done their job. There’s an irritating flutter in her chest.

  Inside, the fluorescent lights of the ER are a welcome slap in the face. Her clogs squeak against the polished floors. Her patient waits, supine, behind a green curtain in the freezing pre-op holding room. As soon as she pulls the thin cloth closed behind her she feels better.

  “Mr. Kells, I’m Dr. McDonnell, the surgeon who will be taking care of you.” She enunciates each word, speaking over the beeping racket that surrounds them, and looks steadily into the man’s broad, ashen face. He says nothing but holds her gaze firmly.

  She picks up his chart. “My apologies. Professor Kells.”

  “Robby,” he says in a hoarse whisper. He has thick eyebrows and a full head of gray hair, and she can easily imagine him at the front of a lecture hall.

  “I’m going to examine you now. Is that all right?”

  He n
ods.

  She rubs her hands together to warm them, lifts his hospital gown, and feels along his pale stomach. “I’m going to press down on your abdomen. Can you tell me if it hurts more or less when I release the pressure?”

  She presses, lets go, and watches his face twist into an ugly grimace. He makes no sound. She’s impressed with his stoicism. His silent scowl makes her think of her father, when he first got sick. Professor Kells is about the same age her father would be if he were still alive.

  She puts her stethoscope in her ears and listens carefully to the four quadrants of his belly.

  “Do you teach at the university?” she asks.

  He nods.

  “What subject?”

  “Philosophy.”

  “Impressive.” She picks up his chart again. “Just want to double check. No history of heart disease or arrhythmia? Any cardiac events at all?”

  He shakes his head.

  “Good. We want to get you back to your books and your students. But to do that I need to find out what’s causing the discomfort in your abdomen. There’s a good chance you have a perforation in your intestine. If you do, and it isn’t repaired soon, you could die. We’re ready to take you to the OR now. Do you give your consent?”

  “Yes.”

  “We’ll do the very best we can for you.”

  He grips her hand with surprising strength. “How about better than your best?” he asks, with a hint of a smile.

  “All right.” She laughs. “You got it.”

  * * *

  —

  Ginny pushes through the heavy swinging doors marked OR 3, SURGICAL ATTIRE ONLY BEYOND THIS POINT, AUTHORIZED PERSONNEL ONLY. She pulls paper booties over her shoes, tucks her ponytail into a surgical cap, and loops a mask over her mouth. She hopes she can keep Professor Kells alive. She doesn’t know him, but from what she’s seen, she likes him. When she told him she was his surgeon, he didn’t flinch. A lot of men his age do when they learn the person about to cut them open is a woman who stands barely five foot three inches tall.

  At the scrub sink, she twists her wedding band from her finger and threads it onto the drawstring of her scrub pants. She knots it once, twice, three times, and thinks briefly of her husband, asleep in bed at home. He used to tell her it bothered him, waking up and her not being there, but after fifteen years of marriage he doesn’t mention it anymore. She takes a scrub sponge, bright orange from Betadine antiseptic, and starts in, fingernails first.

  Tricia, the circulating nurse, joins her at the sink. Her glasses swing on a metal chain as she leans to turn on her faucet.

  “Who’s the scrub nurse on this case?” Ginny asks.

  “Edith. Why?”

  Ginny feels the warmth of a blush. “No reason.” The agitating flutter in her chest returns in full force.

  “How’s that little athlete of yours?”

  “Noah’s great. Asleep right now.”

  “What season is he in?”

  “Soccer. And swimming.” Even on a normal night Ginny doesn’t like to chat right before a case. Tricia knows that, but always tries to get her talking anyway. Tonight, of all nights, she wants to keep her head down and do her job.

  “Busy kid.” Tricia gives her a big smile. “We’re ready when you are.”

  In the operating room Professor Kells is already intubated, and the anesthesiologist has taken up position at the top of the operating table to watch his vital signs. A mask obscures his face, but she can tell it’s Jeff Lee by his dark eyebrows. Edith stands to his right, bent over a tray of gleaming surgical tools. “Hey,” she says, with a soft Southern accent. “Called in again?”

  “Yeah.” Ginny presses her mask to her burning face. “Again,” she adds, too loudly.

  Edith pushes a crinkle of red hair into her cap. “You okay?”

  Ginny pulls the surgical task light closer to Professor Kells’s midsection and the sharp smell of antiseptic solution fills her nose. “I’m fine. Just tired.”

  Edith turns her attention to a neat pile of sponges, gauze, and sutures on another tray, double-checking the counts, and Tricia ducks in with the final paperwork, calling out, “Incision time 11:57 P.M.,” before disappearing again through the swinging doors.

  “Ten blade,” Ginny says. She makes her first cut, from xiphoid to pubis. Then two more cuts, opening the whole belly wide. She holds out her hand and Edith gives her a Bookwalter retractor. The patient’s insides are a sticky mess. He has a perforation somewhere, that’s for sure, and there’s a good chance he’ll go into septic shock before she can find it. Jeff knows it too. His concentration is fixed on the patient’s blood pressure.

  “Shit,” Ginny says.

  “Literally,” Jeff says, grimly attempting a joke.

  She gives a halfhearted snort.

  Across the table Edith repositions the retractor. A thin necklace glints at her freckled throat. “Saline?” she asks.

  “We need to be quick,” Ginny says, unnecessarily. Edith is already irrigating saline through the patient’s abdominal cavity.

  Ginny sweeps her fingers between loops of bowel and along the mesentery, clearing wisps of scar tissue. She calls for suction, and then slowly runs her hands along the length of the GI tract, starting at the stomach and working her way down the small intestine, feeling for a tear. She remembers the last time she and Edith had a case together. It was a long one, five or six hours. When it was done in the early hours of the morning, they had gone for breakfast, despite the fact that they both had trouble keeping their eyes open. Over the years Edith has become a friend. Ginny always looks forward to seeing her at work. But she’s never considered—

  “His blood pressure’s not where I’d like it.” Jeff’s voice snaps Ginny to attention.

  She concentrates on the ropes of pink intestine, gingerly pushing them this way and that until she spies a tiny perforation in a fold of the colon. “Two bowel clamps,” she says, “and get a 3–0 Vicryl suture ready.” She clamps either side of the tear, excises the segment of perforated intestine, and begins sewing the bowel back together, layer by layer. Focused on the stitches, she doesn’t raise her eyes from the operating table until she completes the repair, and Professor Kells’s blood pressure has stabilized.

  TWO

  MARK PULLS OUT of the driveway in his fourteen-year-old Jeep, the mountain hazy at his back, and swerves to avoid his new neighbor Cass and her large black dog. It’s quiet in the car, except for the sound of his restless thumb on the steering wheel. His son Noah is in the backseat, looking out the window. Mark checks his watch. He’s giving a talk this morning to his colleagues in the Department of Fisheries and Wildlife—a presentation of his research on the northwestern spotted frog he hopes will change the course of his career.

  Out from under the wooded canopy of their neighborhood, past a community garden grown wild with sunflowers and sage, Mark makes room for the bicycle traffic on the main road. His left knee jiggles. In the rearview mirror Noah retrieves a football the color of a yellow warbler from his backpack and tosses it in his hands. His backpack looks a little light. Does he have all the books he needs today? Mark doesn’t want to nag. This isn’t easy when all he wants is to go back to when Noah was three or four and everything that went on in his little head was open to Mark. He only needed to ask, and Noah would tell him.

  It’s his son’s last year in elementary school. Next fall he’ll attend Linus Pauling Middle School, a fact never far from Mark’s thoughts. His son will be a teenager soon. Very soon. And Mark isn’t ready. For Noah to be grown up, for him to move out. It will just be Mark and Ginny then. He doesn’t want to think about how empty the house will feel when Noah’s gone.

  Mark turns onto Cedar Lane. On people’s front porches, squat pumpkins and gourds crowd ceramic pots of asters and chrysanthemums and black-eyed Susans. In front yards, signs stic
k out of the bright, wet grass:

  LOCAL CHOICE YES, FLUORIDE NO!

  KEEP OUR URBAN GrOWTH BOUNDARIES: VOTE YES ON 133

  LOVE MAKES A FAMILY

  They pull up to Noah’s friend Peter’s house, a split-level with a lichen-covered roof. A girl wearing bright pink jeans stands on the porch. She holds a black instrument case the size of a brown bear cub or an overgrown badger. She’s in Noah’s class—Lydi or Livi? Mark has met her and her mother once or twice. She lives nearby.

  They wait for a minute, but no one comes out of the house. The girl stares at them.

  “Go get Peter will you?” Mark says.

  Noah opens the car door and leaps out in one smooth motion, the football tucked under one arm. He waves at the girl as he cuts across the grass. Then he flips the football high into the air and jumps to catch it, his body making a shallow arc like an undrawn bow.

  Mark’s whole department will be at his talk this morning, and also the dean…maybe. Hopefully. His research project needs just a small percentage of the fifty million dollars recently donated to the university to fund natural disaster research. Everyone was getting a piece of it: the geophysicists, the people at the wave research institute, and of course the seismologists. But they were all focusing on the Cascadia subduction zone off the coast of Oregon, when the more immediate danger—Broken Mountain—was right under their feet. His research, which centered on the connection between geothermal activity and animal behavior, revealed strong evidence that the mountain could erupt sooner than anyone thought. Possibly in the next twenty years. But his project had been awarded exactly zero dollars.