New York City, 1967-1971

In the back row of lectures, Jacque and Hal Helderman were often nearby. Hal would later become an academic nephrologist at the University of Texas Southwestern in Dallas, where Jacque and I would one day visit him. In those early months, however, we knew him simply as another tired student trying to keep pace with anatomy, physiology, and the accumulating vocabulary of disease.

Our own connection began less ceremoniously, over the glassware and reagents of biochemistry. The laboratory smelled of alcohol, hot metal, and chemicals whose names I could barely remember once the practical examination was over. We measured, mixed, heated, and waited for colors to appear in test tubes. The work demanded attention, but it also left room for glances across the bench and the small, unplanned exchanges through which familiarity grows.

Jacque already knew more about the practical side of medicine than most of us. She worked in the blood bank at Downstate and moonlighted across state lines at Greenwich Hospital with Dr. Queenan. Her schedule made my own seem almost leisurely. She moved between Brooklyn and Connecticut, between the formal demands of school and the urgent, often unseen labor of transfusion medicine. When she spoke about blood banking, she did so with the calm precision of someone accustomed to responsibility.

I was learning medicine from textbooks and laboratory exercises. Jacque was learning it from the patients whose blood had to be identified, matched, stored, and made available at the right moment. The difference mattered. It gave her an assurance I admired, even when I did not yet understand how much work stood behind it.

Our courtship developed through mishaps rather than declarations. After a Brooklyn party, I had consumed a few more beers than wisdom recommended. I remember the cramped street, the close-packed cars, and my 1966 Chevrolet sedan wedged into a parking space with a fire hydrant directly behind it. I tried to muscle the car free. Instead, I backed into the hydrant.

The impact was not dramatic, but it was conclusive. The car stopped, the hydrant remained indifferent, and my confidence in my own driving diminished sharply.

Jacque, clearheaded and practical, took the wheel. She delivered me safely back to my apartment while I sat beside her in embarrassed silence. The incident should have made me cautious about being seen with her. Instead, it gave her one more reason to question my judgment and me one more reason to appreciate hers.

Then came the ski trip and the plaster cast.

When Jacque returned to class, the cast extended heavily from her hand up her arm. It interfered with note-taking, carrying books, and nearly every other small task that medical school imposed without mercy. At the end of one day’s lectures, she asked whether I might help carry her books and belongings home to Manhattan.

I gladly agreed, though I had not yet appreciated what that request would mean. We crossed from Brooklyn into the city’s larger current of traffic and pedestrians, carrying the day with us. By the time we reached York Avenue, the light had softened, and the apartment building’s entrance smelled of rice pudding and old stone.

At the top of the stairs, Jacque opened the door.

Alfie came forward with the confidence of an animal who considered the apartment, the building, and perhaps the entire Upper East Side his rightful domain. He was a black-and-tan terrier mix, compact and alert, with immense intelligence and an unflinching self-confidence. He examined me without haste, as though deciding whether I deserved admission.

“This is Alfie,” Jacque said.

Alfie did not need an introduction. He had already made his judgment.

I had owned dogs before, but Alfie was different. He carried himself like a small, self-appointed magistrate. His eyes were bright, his attention exact, and his confidence entirely out of proportion to his size. Before long, he became my second-best friend, though I understood that he had seniority and that no formal vote had been taken.

That afternoon changed the shape of our days. We had met casually through laboratories and lectures, but now I had a reason to go to York Avenue, and Jacque had a reason to expect me. The six flights became familiar. So did the diner below, the smell of warm rice pudding, and the particular fatigue that settled over us after a day at Downstate.

The city remained cramped and inconvenient, but we began to make a life within its limits. On sunny afternoons, we climbed to the tarred roof of the building and grilled hot dogs on a little hibachi. The roof held the day’s heat, and the air smelled of charcoal, rendered fat, and tar. Beyond the neighboring buildings, New York opened in fragments: water, bridges, brick walls, rooftop machinery, and a sky larger than the streets allowed us to imagine.

Alfie treated the roof as a private kingdom. He moved among us with great purpose, inspecting the hibachi, the food, and the edges of the roof. Jacque watched him closely while I tried to keep the hot dogs from burning.

“You’re turning them too often,” she said once.

“I’m trying to prevent burning.”

“You’re preventing cooking.”

Her cast made even small tasks difficult, but she refused to make a ceremony of her injury. She adapted. I carried what needed carrying, and she found ways to do the rest. Medical school had already taught us that the body could make demands at inconvenient times. Life with Jacque taught me that dependence did not have to diminish anyone.

We walked Alfie past Gracie Mansion, where Mayor John Lindsay resided, and down toward the East River. The water carried the city’s refuse and reflections together, shifting with the tide. I sometimes cast a fishing line into the current, hoping for flounder or striped bass. I rarely caught anything. Still, the fishing gave me a way to take the edge off my urban existence. The rod rested in my hands, the line moved with the water, and for a little while I was not a student being sorted by alphabetical order or measured against the next examination.

Jacque stood nearby with Alfie. The dog watched the water as if he understood the purpose of the expedition better than I did.

Those walks made our relationship less a matter of appointments than of repetition. We studied, attended lectures, crossed the city, climbed stairs, fed Alfie, and returned to the next day’s obligations. The ordinary became intimate. A shared subway ride, a stack of books, or a meal eaten after too many hours in the laboratory could carry more meaning than any carefully arranged evening.

Yet Downstate did not permit us to forget itself. Its demands followed us home. The lectures accumulated. The laboratory reports waited. The alphabet continued to place Herold and me together, regardless of whatever else had begun to change in my life. Jacque’s work at the blood bank and her moonlighting with Dr. Queenan added another layer to the strain. She could be beside me on York Avenue one evening and committed to the blood bank or Greenwich Hospital the next, her attention divided by the needs of patients and the expectations of the school.

I began to understand that affection could not be separated from endurance. Loving someone in medical school meant learning the geography of fatigue, recognizing when conversation was welcome and when silence was kinder, and accepting that plans could be overturned by an examination, a laboratory requirement, or a hospital obligation.

The hydrant accident had embarrassed me, but Jacque’s response to it had also revealed something essential. She did not rescue me theatrically. She simply took the wheel when I was no longer in a condition to drive. The cast had done something similar in reverse. It had made me useful in small, concrete ways. Carrying her books was not a grand gesture. It was what the moment required.

Looking back, I now understand that our closeness was built less by exceptional events than by the accumulation of such necessities. The city kept narrowing our choices, and medicine kept consuming our time. We answered by creating a routine wherever we could: the laboratories, the lectures, the six flights to York Avenue, the roof, the river, and Alfie’s watchful presence.

I also understand that the first security I felt with Jacque came not from knowing what the future would bring, but from seeing how she met the present. She worked, studied, adapted to a broken wrist, drove when I could not, and made room for a dog who believed himself indispensable. In that small apartment above the diner, our lives began to overlap completely.

The feeling did not make medical school easier. If anything, it gave the difficulties more weight. There was now more to lose than sleep and grades.

The next disruption arrived as medical-school disruptions always did: without regard for whatever private rhythm we had managed to establish. The city, the school, and the alphabet were not finished with us. Our new routine had begun, but it would have to survive the next demand placed upon us.

End of chapter one. 4 more chapters in the full book.