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Anton was shirtless, and for two good reasons. First, it was going to be a hot day. Second, his abdomen was a rock. He was ripped, was Anton the pool guy; he looked like a stud on the cover of a romance novel. If you shot bullets at Anton’s abdomen, you’d want to do it from an angle, in case of a ricochet. What did he eat? Mountains of pure protein? What was his workout? Cleaning the Augean Stables?

Anton glanced up, smiling from under the shimmering panes of his Wayfarers. With his free hand he waved at Clint, who was watching from the second-floor window of the master bathroom.

“Jesus Christ, man,” Clint said quietly to himself. He waved back. “Have a heart.”

Clint sidled away from the window. In the mirror on the closed bathroom door there appeared a forty-eight-year-old white male, BA from Cornell, MD from NYU, modest love handles from Starbucks Grande Mochas. His salt and pepper beard was less woodcutter-virile, more lumpen one-legged sea captain.

That his age and softening body should come as any kind of a surprise struck Clint as ironic. He had never had much patience with male vanity, especially the middle-aged variety, and cumulative professional experience had, if anything, trimmed that particular fuse even shorter. In fact, what Clint thought of as the great turning point of his medical career had occurred eighteen years earlier, in 1999, when a prospective patient named Paul Montpelier had come to the young doctor with a “crisis of sexual ambition.”

He had asked Montpelier, “When you say ‘sexual ambition,’ what do you mean?” Ambitious people sought promotions. You couldn’t really become vice-president of sex. It was a peculiar euphemism.

“I mean…” Montpelier appeared to weigh various descriptors. He cleared his throat and settled on, “I still want to do it. I still want to go for it.”

Clint said, “That doesn’t seem unusually ambitious. It seems normal.”

Fresh from his psych residency, and not yet softening, this was only Clint’s second day in the office and Montpelier was just his second patient.

(His first patient had been a teenager with some anxieties about her college applications. Pretty quickly, however, it had emerged that the girl had received a 1570 on her SATs. Clint pointed out that this was excellent, and there had been no need for treatment or a second appointment. Cured! he had dashed off on the bottom of the yellow legal pad he used to take notes on.)

Seated in the leatherette armchair opposite Clint, Paul Montpelier had that day worn a white sweater vest and pleated pants. He sat in a hunch with an ankle over his knee, hanging onto his dress shoe with one hand as he spoke. Clint had seen him park a candy-red sports car in the lot outside the lowslung office building. Working high up the food chain of the coal industry had made it possible for him to buy a car like that, but his long, careworn face reminded Clint of the Beagle Boys, who used to bedevil Scrooge McDuck in the old comic strips.

“My wife says—well, not in so many words, but, you know, the meaning is clear. The, uh, subtext. She wants me to let it go. Let my sexual ambition go.” He jerked his chin upward.

Clint followed his gaze. There was a fan rotating on the ceiling. If Montpelier sent his sexual ambition up there, it was going to get cut off.

“Let’s back up, Paul. How did the subject come up between you and your wife in the first place? Where did this start?”

“I had an affair. That was the precipitating incident. And Rhoda—my wife—kicked me out! I explained it wasn’t about her, it was about—I had a need, you know? Men have needs women do not always understand.” Montpelier rolled his head around on his neck. He made a frustrated hiss. “I don’t want to get divorced! There’s a part of me that feels like she’s the one who needs to come to terms with this. With me.”

The man’s sadness and desperation were real, and Clint could imagine the pain brought on by his sudden displacement—living out of a suitcase, eating watery omelets by himself in a diner. It wasn’t clinical depression, but it was significant, and deserving of respect and care even though he might have brought the situation on himself.

Montpelier leaned over his growing stomach. “Let’s be frank. I’m pushing fifty here, Dr. Norcross. My best sex days are already gone. I gave those up for her. Surrendered them to her. I changed diapers. I drove to all the games and competitions and built up the college funds. I checked every box on the questionnaire of marriage. So why can’t we come to some sort of agreement here? Why does it have to be so terrible and divisive?”

Clint hadn’t replied, just waited.

“Last week, I was at Miranda’s. She’s the woman I’ve been sleeping with. We did it in the kitchen. We did it in her bedroom. We almost managed a third time in the shower. I was happy as heck! Endorphins! And then I went home, and we had a good family dinner, and played Scrabble, and everyone else felt great, too! Where is the problem? It’s a manufactured problem, is what I think. Why can’t I have some freedom here? Is it too much to ask? Is it so outrageous?”

For a few seconds no one spoke. Montpelier regarded Clint. Good words swam and darted around in Clint’s head like tadpoles. They would be easy enough to catch, but he still held back.

Behind his patient, propped against the wall, was the framed Hockney print that Lila had given Clint to “warm the place up.” He planned to hang it later that day. Beside the print were his half-unpacked boxes of medical texts.

Someone needs to help this man, the young doctor found himself thinking, and they ought to do it in a nice, quiet room like this. But should that person be Clinton R. Norcross, MD?

He had, after all, worked awfully hard to become a doctor, and there had been no college fund to help Clint along. He had grown up under difficult circumstances and paid his own way, sometimes in more than money. To get through he had done things he had never told his wife about, and never would. Was this what he had done those things for? To treat the sexually ambitious Paul Montpelier?

A tender grimace of apology creased Montpelier’s wide face. “Oh, boy. Shoot. I’m not doing this right, am I?”

“You’re doing it fine,” Clint said, and for the next thirty minutes, he consciously put his doubts aside. They stretched the thing out; they looked at it from all sides; they discussed the difference between desire and need; they talked about Mrs. Montpelier and her pedestrian (in Montpelier’s opinion) bedroom preferences; they even took a surprisingly candid detour to visit Paul Montpelier’s earliest adolescent sexual experience, when he had masturbated using the jaws of his little brother’s stuffed crocodile.

Clint, according to his professional obligation, asked Montpelier if he’d ever considered harming himself. (No.) He wondered how Montpelier would feel if the roles were reversed? (He insisted that he’d tell her to do what she needed to do.) Where did Montpelier see himself in five years? (That’s when the man in the white sweater vest started to weep.)

At the end of the session, Montpelier said he was already looking forward to the next, and as soon as he departed, Clint rang his service. He directed them to refer all of his calls to a psychiatrist in Maylock, the next town over. The operator asked him for how long.

“Until snow flurries are reported in hell,” said Clint. From the window he watched Montpelier back up his candy-red sports car and pull out of the lot, never to be seen again.

Next, he called Lila.

“Hello, Dr. Norcross.” The feeling her voice gave him was what people meant—or should have meant—when they said their hearts sang. She asked him how his second day was going.

“The least self-aware man in America dropped in for a visit,” he said.