Mervyn texted to look in on me at seven-thirty, which I agreed. Normally I rose before six, but he correctly surmised I’d need more sleep after the previous evening. I’d woken at my usual time, used the bathroom, and gone right back to bed.

He looked fresh and slightly shower-damp, and I envied him his bright-eyed, bushy-tailed presence as he pulled a chair to my bedside and we exchanged greetings.

“Last night you had a lot going on,” he began. “How are things today?”

I took a breath to speak and coughed, although the cough had changed into something barkier and brassier that actually stopped.

“I see,” laughed Mervyn. “You’re ready to compete in the Olympics.”

“Yeah, the track needs to watch out.”

“Sinuses?”

“I have a headache, so not perfect.”

“How bad? Mild, moderate, severe?”

“Mild-moderate.”

“Throat?”

“Better. Not sore today.”

“Lungs?”

“I still have that weird close feeling under my breastbone, but it doesn’t hurt to breathe.”

“Abdomen?”

“Not settled 100%, but a lot better, I think. It’s an ache, not a pain.”

“Hungry at all?”

I shook my head. Having one of these infections was like being in a strange, second world in which food didn’t matter.

“Nausea?”

“No, just not hungry.”

Mervyn pulled out his kit and quickly got my temperature, sats, and blood pressure. He looked in my ears, nose, and throat. After so many repetitions I was beginning to find it less awkward to have his otoscope up my nose, but it still struck me as a compromising position. Then he pressed on my face and palpated my neck, both of which were still sore.

“Let’s listen to your chest,” he said, placing his stethoscope under my nightgown and asking for many breaths and “99s.”

“Lie down so we can see about that belly of yours?”

At this point I knew how he wanted me draped and managed my nightgown while he drew the covers to hip level.

He listened quickly to my bowel sounds and then made eye contact to start palpation, which he began with a very soft touch. Both flexures of my colon were tender, and he stopped at light pressure.

“You sure you’re not in frank pain anywhere?”

“I’m not.”

“Okay, in that case we’ll skip deep palpation today. It really seemed to set your bowel off last night. But can I get you a hot pack? I think it’d help that ache.”

I agreed enthusiastically. Mervyn’s flannel hot packs had become legendary for me. They’d practically gotten him hired, and there was no way I’d refuse. The moment he draped my abdomen I felt at least half my body relax.

Mervyn retook his position at my bedside and looked at my chart on his tablet, so I knew his summary was forthcoming.

“Has it been a week you’ve had this bug?”

I counted days. “Yes, just over.”

“You’re still running hectic fevers, your sinuses and lungs are congested, and the virus is irritating your GI tract to the point that you’re not getting enough nutrition. Your previous doctor would have started you on a Z-pack.”

“True.”

“I don’t want to do that. I think frequent antibiotic exposure has contributed to your chronic bowel pain. I checked in on a treatment plan with Dr. Alan, and he’s in agreement. I’m right here keeping tabs on you, and we can always take a different tack if you don’t improve, but I’d like to give your body a chance to clear this on its own.”

“Do you think it will?”

“We’ll give it every opportunity. We’ll steam your airways and help you with warm compresses on your face and abdomen. You’ll use the inhaler once daily like I taught you for your lungs until you’re not having long coughing jags, and as I showed you for your sinuses until your face doesn’t hurt. We’ll do respiratory therapy exercises to help clear your chest. We’ll irrigate your bowel every several days as needed. You’ll get a little light activity but mostly rest. And I want you to get a few more calories than you are currently. It’s okay to run a small deficit, but not like this. You were shaky yesterday.”

“How can that work? I can barely eat now. Little disgusts me more than nutrition shakes. When I feel this way, I hate anything sweet.”

“Let me confer with Ryan? I promise not to disgust you; I just want you getting maybe 300-500 more calories a day. A little more protein and olive oil will add up quickly enough and do you good. We’ll hide them to the best of his abilities.”

I nodded; I did trust Ryan in this regard. At this point Ryan understood my tastes better than I did, sick and well.

“So what do you think about trying Le Sanitarium Mervyn?”

I agreed to try and thanked him for his care and consideration. “But I don’t want to take advantage, Mervyn. Nursing me through respiratory infections, of which I can get a lot, was never in the job description. I’m paying you for what I assumed would be maybe one enema a week, not hours a day of care.”

“Sandrine, for what you pay me, not including the free rent, utilities, and occasional delicious prize from Ryan’s kitchen, I used to have to care for 15 or even 20 much sicker patients. In much longer shifts. And some of those patients or family members were verbally abusive, and a few threatened physical violence. Or more than threatened.”

“This job, with its charming cottage on a beautiful estate, caring for a genuinely good person who appreciates my services, in the shortest shifts I’ve ever worked, and with a patient whom I can follow long term to know if I’m really making a difference…this is beyond any of my dreams for my profession. You truly don’t need to pay me a cent more.”

“How about perks? A dedicated slot in my gym to work out, day charters on Maribelle, being on Ryan’s regular dinner list?”

I could see him brighten at Ryan’s dinner list. “I can tell that appeals. Let me talk to Ryan.”

Mervyn nodded, eyes smiling over his mask.

“And if you’re using Dr. Alan for consults and scripts, he should be on a retainer. Can you please broach the idea?”

Mervyn agreed. “If I may be so bold, I think you should try him as your primary. You deserve someone who will look at your total picture instead of playing whack-a-mole with what’s happening in the present moment.”

“I’d be open if he is. Please get Chella his info?”

“Yes, of course. But now I need ‘cooperative patient’ Sandrine, not ‘fair businesswoman’ Sandrine. It’s time for you to breathe a lot of steam.”

There was something about the way Mervyn kept a reassuring hand between my shoulders when he had me under the towel that I loved. I wasn’t claustrophobic, but his touch, or gentle backrub if I was coughing, seemed like a magical reduction of the world to a sanctuary space.

I supposed for Mervyn the hand was actually a meter, which he used to feel if I wasn’t breathing deeply enough and would coach me to take slower, more expansive breaths, but I enjoyed the gentle human connection, even if I was red-faced in the dark.

When the water stopped steaming, he had me sit up while he auscultated my breath sounds again. He coached me on how to exhale to help clear my lungs without the irritation of coughing, and then put me back under the towel with a fresh bowl of hot water and his guiding hand.

When I emerged, he handed me a glass of water, from which I sipped but didn’t drink.

“You’re not drinking enough, Sandrine. Your lungs and sinuses are going to be very hard to clear this way.”

“Drinking with a blocked nose and my face aching into my teeth Is miserable. Feeling like this is part of why I’ve opted for antibiotics before. And they do work, starting by day 2.”

Mervyn took my crankiness in stride, speaking kindly and logically. “You need more fluids on board than we can get you with retention enemas and what you’re able to drink. And it’s okay; you have supportive care now, which you didn’t before. If this is as much as you can handle, we’ll supplement with IV fluids.”

“I feel like a failure.”

Mervyn shook his head. “No need. I’m not grading you. I’m here to help you feel better. There’s absolutely no reason we can’t help you with a bag or two of saline. That could really get us ahead in your face and chest, and I should have offered sooner. Let me send a text.”

By midmorning I was hooked to a saline drip with hot packs on my face and belly, feeling more comfortable than I had in days. For once, I wasn’t coughing. Mervyn had gone off to discuss menus with Ryan, and the combination of warmth and hydration eased me to sleep.

Mervyn’s touch on my arm was gentle, his voice soft. “Sandrine, I’m sorry to wake you. It’s afternoon.”

I stirred and he collected the various hot packs, now body temperature, folding them in a neat pile on the dresser. Light slanted in from the courtyard.

“Feeling any better?”

I took a moment to be conscious in my body. The fluid and sleep had helped, but not in the way two doses of azithromycin would have. One side of my face hurt. My abdomen was still tensed and achy. My chest wasn’t right, but at least I hadn’t woken myself coughing, and the headache was almost gone.

“I—“ I got out before coughing. The cough was barking, unproductive, and hurt.

Mervyn made sympathetic eye contact and rubbed my chest, waiting for my answer. Then he asked me more questions. He unhooked the empty saline bag but left the capped needle in my arm, taping it over so it wouldn’t catch. He took my temperature.

“The fluid helped your fever. You’re under 100 in the afternoon, an improvement. But I woke you up so you can eat. It’s important.”

Mervyn stepped out to get my lunch. Although they whispered, I heard pieces of Ryan and Mervyn conversing in the hall.

“…So sick…relieved you’re…” I heard Ryan say.

Mervyn’s voice also didn’t carry enough for me to hear. “…Without antibiotics…last night…pale and nearly fainted….fluids and food….try to get her…again this evening.”

“Of course, anything you need,” said Ryan, and I heard the clink of his handing off a tray.

Ryan’s sweet potato soup was a little heavier than usual but not offputting, and I worked to finish the bowl. I didn’t want my staff worried about me.

Mervyn handed me the water glass, pointedly, and gave me a look that I could read as a look even over his mask. “Don’t get out of the habit. One bag has probably barely caught you up, and we don’t want you chained to an IV for days.”

I nodded and downed a third of the glass instead of the two sips I would have taken on my own. I could feel a lymph node in my neck hurt as I swallowed, and the ache of referred pain in my teeth.

“Mervyn, how long would we wait to start an antibiotic if this isn’t getting better?”

“It would depend on your symptoms. If you get a lot worse, quickly, we’d start one right away, IV if needed. But if you just linger feeling like you do now, no better, no worse, we’d give it about three days.”

I nodded and felt traitorous wondering if chronic IBS was, in fact, worth being able to down a Z-pack the moment I could tell something was worse than a cold.

Mervyn seemed to intuit the direction of my train of thought. “It could take 18 months to two years of keeping you off antibiotics to know if we’d improve your IBS. I know you feel pretty awful now and that feels slow. But if your recent chart is accurate, you’re down to 1-2 of these infections per year, not the 4-6 you told me you were having before.”

“That’s accurate over the last two years.”

“Okay, so, making a generous estimate, you endure some extra respiratory suffering for maybe 12 days over two years. As compared with what? Minimum 120 days suffering with IBS aches, and 20 days with intense belly pain and nausea? Or 240 days and 40 if you have bad years?”

I nodded. Mervyn’s math was right.

“I don’t intend an antibiotic holiday to be the only thing we try. Dr. Alan, if we get him as your primary, has good instincts and a lot of experience. He already has many ideas for things we can do to see if they positively influence how well your gut works and feels.”

That didn’t sound bad.

“Dr. Alan also has thoughts about why you suffer more and longer with respiratory infections, and things he’d like to test there. So maybe we can have you suffering a lot less overall and this won’t seem such a difficult bargain.”

I nodded my okay.

“You’re a thinking person and know your body, and I never want to tell a patient to just trust the care team. If you ever feel something is really wrong, tell us. But I do want you to know you can relax a little and let us care for you. It’s literally my full-time job.”

Here, Mervyn winked. “And now that I know that you, too, enjoy an enema, it seems I’d probably still have employment even if we 100% fix your health issues.”

I smiled under my mask. I hadn’t really been capable on my own of imagining an IBS-free life, but I let my mind wander to a scenario in which I felt great and Mervyn brought me enemas just for fun. To say the least, it didn’t seem bad. “Well, it would be rather indulgent, but yes, you would not be without employment.”