Alice & Oliver

by Charles Bock

  So he returned to Rye and shut the door to his room and wouldn’t answer any more of her questions, he ignored his stepdad’s knocks, even stopped using his phone, basically the kid shut himself down, retreating into the quiet of that room. The most he admitted, he always felt weak. Whatever was happening to him, it would stop. He told his parents this. Claimed to be sure of it. But the only thing that stopped was his eating. No appetite. Through his closed door, his mom would hear him moaning. Whenever she wanted to know what was going on, he complained: stomach pains. She couldn’t figure out whether the boy was sick, if it was in his head, what. But she also knew her son had always been sensitive. Even from a toddling age, he’d been too smart for the rest of the neighborhood kids. The mother worried that her son’s problems might be mental. His stepdad meanwhile was losing what little patience he had left. He pounded on the door, told the kid to snap out of it. Even the kid started thinking he might have been making shit up. The boy started questioning every single thing he knew about himself. Nobody had any clue what to do. And he’d lost sixty-five pounds in three months. He was weak, frail, hunched over when he walked, looking like an old man. But he was just nineteen years young. Doesn’t happen with a boy that age.

  Then he got a fever. Hundred and five. Parents hauled him to the local ER. The emergency room doctor in Rye gave him aspirin. Three days later the kid’s at a hundred and six. After all this, his mom got an idea, finally went through her organizer, and looked up Carmen, her old friend from down the hall. Carmen’d been a nurse for twenty-plus years. Carmen told that boy’s mother, Get off your ass. You get that child to a different emergency room. No small-town country bumpkin place. A serious emergency room at a big hospital. They ask what’s wrong, act like it’s the first time you’re seeing anybody. Those triage emergency room folk find out a general practitioner’s seen her kid, they hear he went to a different ER, they’ll think it’s under control, send his ass right back home. Carmen told Evelyne to make a ghetto stink: No we can’t take care of him. You have to treat him. We can’t have this no more. ER can’t have no young man sick with his moms screaming bloody murder around all the other patients.

  Carmen told her that God understands a white lie. Sometimes you have to do it. They can’t kick him out—goes against the oath.

  The mom and her boy ended up at Sinai ER, telling the admit staff his story, his symptoms, everything that Carmen said to tell them. And wouldn’t you know, their story got the emergency doctors listening. The doctors administered all the tests his momma had hoped for. And those tests led the boy to a stomach specialist. Finally, after all this time, he got to deal with someone with expertise. When the specialist heard their story, he got concerned. He did tests. Boom—abscess lining his kidney. Monster size. All sorts of toxic bile in there. But before they could start doing anything about the abscess, they had to pump his belly. They put the kid on IVs. His third day in the hospital bed, he broke down. Tears streamed down his face. I’m hungry, he told his mom, I’m actually hungry.

  Requisite Business

  “Lie as still as you can,” Eisenstatt said.

  “It’s cold,” answered Alice.

  “Nurse, more blankets.”

  “Blankets, Doctor.”

  “Before we start,” Alice said. “If you could please—could you explain to me what you are doing, during the procedure, what phase we’re at?”

  “I’ll do what I can.”

  “Kindly appreciated.”

  “What we’re going to do is start at the area near the top of the back of the hip bone, the posterior iliac crest. It’s our entry point. Still, please.”

  “Mmm.”

  “This is lidocaine. A local anesthetic. You’ll feel a little pinch.”

  “Nnn.”

  “More lidocaine,” Eisenstatt said. “Now we’re going deeper.”

  “Ah. Ah. Ah.”

  “There. Let’s let that sit.” The doctor waited. “Please, if you can remain still.”

  “I’m trying.”

  (Stray odd sounds; the click of a vial twisting and popping open.)

  “I think these are extra.”

  “Yes, Doctor.”

  “Do you have yellow?” he said.

  “I’ll get some,” answered the nurse.

  “Great. Okay. Okay.”

  (Faint scratches. Metal objects impacting metal. Echoes in a pan.)

  “Okay?” said the doctor. “How you doing, Mrs. Culvert? Are you doing okay?”

  Her answer was a light sob, a whispered chant: Shamalam. Accept.

  —

  Oliver eventually found the M bank of elevators, the stroller wheels jiggling over the slightly raised grooves when the door slid open. His luck held and the child remained comatose in the lobby during the wait. He started perusing an unattended issue of Schlep, enjoyed the cover story (“Venice: You Mean I’m Supposed to Get Around in a Kayak?”), as well as the little gray sidebar infographic (“And the Smell!”). The office door opened. A woman in a heavy, formless coat came out, followed by a tallish young man. He was pale, moving creakily, and so skinny that his powder-blue sweater engulfed him, the letters of its white TAR HEELS logo folding onto one another. The woman was cursing the office, wondering how could they expect her to get this kind of money? When she saw Oliver and the carriage, she went silent. Her son took her hand. Which of them led the other away was unclear.

  Within minutes, Oliver was summoned by the same youngish financial aid woman as earlier, Miss Culpepper, who smiled that same politely annoying smile, and casually guided him into that same sparse cubicle, where she informed Oliver that because of the low ceiling on their family insurance policy, a hold had been placed on his wife’s patient status.

  Oliver tamped down on his rage. He had a role—in doctor meetings, this meant asking follow-up questions about side effects, getting clarifications without being obnoxious. Keeping his opinions to himself. For Alice, he swallowed and shut up. So now he kept his voice low and respectful, and explained out a piece of first-grade math.

  “I checked with Unified on Friday. Our policy cap is three hundred thousand. We’re around one fifty, is what they told me.”

  A finger gracelessly hit what sounded to Oliver like the return key.

  “Your wife has leukemia?” Miss Culpepper’s voice was disinterested. She pounded the key a few more times. “We have here her needing a bone marrow transplant? Bone marrow transplant’s a major procedure.”

  “That’s months away. You can appreciate—we aren’t close to that point.”

  “Transplant costs more than what your whole policy covers.”

  Taking a moment, giving his best, most apologetic, most adult, taking-you-in-my-confidence look, he explained to Miss Culpepper about the small policy they’d basically gotten for Alice’s pregnancy, how they should be able to transfer to another policy without hitting any rigmarole about preexisting conditions. He’d checked into all this, he said. He wasn’t looking for pity: “But while I’m figuring out our best next step, if we’re months away from even approaching our cap, I guess what I’m asking is: Why can’t we just keep using the policy we have?”

  Her eyes had glazed. “I can respect your situation, Mr. Culverts. I hope you can respect ours.”

  Oliver squirmed in place, decided to not correct her about his last name.

  “Hospital procedure,” she continued. “Once you reach a certain level on your insurance coverage, we flag your status.”

  “We’re not even—”

  Yet again he caught himself. Behind him, though, damage had been done: the baby carriage stirring, minor tremors followed by calm, silence. A near miss. Oliver’s panic about the child awakening receded. He jutted in his chair now, whispering across the desk with the fervor of a person whose spouse’s life depended on him being understood: “We still have one. Hundred and. Fifty. THOUSAND dollars. Alice was in the hospital for thirty-four days in New Hampshire and we didn’t spend that much.”

  “I’m s
ure you can appreciate, billing rates are a little different here in the Upper East Side.”

  “Look, you really want to get into this, you want to get into specifics? Okay, say Unified has their way, just say we lose the appeal—”

  “Mr. Culverts—”

  “More of that billing’s going to be classified out-of-network. It’ll be a hit for me, a massive hit, fine, but it actually comes OFF our policy total of spent insurance money. We’ll end up being MORE under the cap.”

  “I’d appreciate it if you please didn’t raise your voice at me, Mr. Culverts.”

  “I’m WHISPERING.”

  “I’m not raising my voice at you, am I, Mr. Culverts? I’m not losing my temper at you.”

  “I’m not losing my temper at YOU, either, Miss Culpepper. If I’m upset, which I’m not, but if I am, my upset is not because I have anything against you, I don’t. It’s you as the de facto representative of a bureaucratic nightmare that’s creating all this BULLSHIT—”

  “So you’re screaming now?”

  “—instead of doing what it should be doing, which is to make sure my wife stays alive.”

  “This hospital’s run by a private management company, okay? This management company, they has they own policies, okay? End of the day, I don’t make policy. My job, I make sure the hospital gets paid for the services it provide, okay? That ain’t me, that’s policy. If you need, we got all kinds of financial aid and payment options to our patients. I’ll give you the form.”

  “Miss— Where…How do I…” Oliver reset himself. “I have a little software business. That’s what I do, Miss Culpepper. It’s not big, I’m the only full-timer. But when I hand in the tax forms for any financial aid papers, it looks like we’re loaded, like that lump is the business’s regular yearly income. Really, it’s all the money to get through development and onto the market.”

  She did not seem to follow, but stayed silent until she was sure he’d finished. “Until you rectify this situation,” Miss Culpepper said, “your wife’s appointments have to be approved once at a time. There’s a hold. On Mrs. Culverts’s account. Hospital won’t make appointments after first of May for her. So that’s three months you have. You still under the cap come May we can revisit the situation. If I were you, though, I’d have this problem solved by then.”

  This is the only way we know to make you better

  IT TOOK ANOTHER hour before they let him back inside, where electric light, bright and pitiless, beat down on the sight. His wife was curled on her side, protecting herself in a sad imitation of a cocoon. Her bright blue wig, now askew, looked ridiculous, and worse. Her eyes were shut, but she wasn’t asleep, just recovering, breathing softly, a thin white sheet over her torso.

  An unopened can of cranberry juice sat next to a plastic cup near her head. A spot of blood marred the plastic exam table paper, which was creased and crumpled and had been ripped along the top edge. Oliver softly kissed her raised cheek. She was fragrant with heat and sweat, her skin chalky on his lips. Oliver kissed one shut eyelid. Then the other one, half-pressed against the starched sheet. Alice lifted her hand to his cheek. Fluttering eyes were unfocused, her smile sleepy. She looked beyond his shoulder, to the carriage, checking.

  “Dr. Howard Eisenstatt, MD, is upset at me.” Alice sounded airy, girlish, a little drugged. “I wouldn’t let him tell me any results until you came back.”

  A brain trust of physicians were right outside the room, gathered over the equipment tray, checking the same paperwork and looking at the same clipboard; Oliver hadn’t noticed them, but now they began entering. Eisenstatt stepped forward, his forehead and cheeks still tinged with the flush of exertion, his expression uncertain. How was Alice doing? he asked. Indicating concern as to whether it was okay to talk, he glanced toward the carriage.

  “Thanks for asking,” Alice said. “It might be a good idea to use our indoor voices.”

  Eisenstatt helped himself to a cup of water, looked toward the nurse, who was prepared with a Magic Marker and then a dry-erase board the size of a lunch tray. “I know it’s been a long day,” he said.

  The doctor uncorked his marker and started writing, first on the left, then the right side of the marker board, slanted, quick, and a little sloppy, forest-green capital letters appearing parallel to one another:

  Eisenstatt accentuated the T with a squeaky, tight checkmark. “We need to get you to the transplant,” he said. Circling the I, he continued. “You’ve been through induction. That was big, and you came through with flying colors.”

  “Doctor?” Alice’s head was lying on its side, resting atop her hands. “This is going to explain my aspirate results?”

  “The board allows us to understand your results as they relate to the bigger—”

  More knocking. An orderly entered with a carton of milk procured from a lunch tray. Alice thanked Miguel, then looked over to Dantelle, and mouthed Thank you. Oliver had already started toward the sink, where he began washing out the plastic nipple. Watching, the doctor seemed impressed, but also taken aback.

  “I’m with you,” Oliver said, still pouring milk into the plastic baby bottle liner.

  Only when the nipple top had been screwed back onto the bottle did the doctor allow his lips to form that tight smile, by now recognizable as a sign of growing irritation. “We want to make sure the cancer stays in remission,” Eisenstatt said. “The way to do that is to stay on top of things, be proactive—everyone with me? Standard plan of attack. Two months after induction, we bring you into the hospital, give you another dose of chemo. This time it’s a high-impact dose of cytarabine. We call this consolidation.”

  On the chalkboard he scribbled:

  “During consolidation, you’ll stay in the hospital for five or six days. For another week or two, your counts will plummet, that’s typical, and you’ll need a fair amount of support. But we’ll also do your HLA typing, and get searching for your donor. HLA takes about three weeks to process. Gold-plated, best-case scenario, one consolidation, we find a match while you’re recovering, move right into the transplant.”

  “That happens?” Oliver asked.

  “It does.” The doctor’s voice trained on Alice, making sure she’d heard him.

  “You are white, American, of European descent,” Eisenstatt continued, “so the numbers are as much in your corner as anyone could ask. If you were an Eastern European Jew, the history of pogroms and the decreased breeding pool complicates a lot of genetic structures. Or with African Americans, the donor pool isn’t as deep as we’d prefer. I don’t make a habit of predictions, and can’t promise anything. But in the case of Mrs. Culvert, it’s conceivable we’ll find a match. I’d say finding one quickly is within the realm of possibility.”

  “And if not?” she inquired, from her little protective shell.

  “We will,” Oliver said.

  “I know. But if not—”

  “We keep searching,” Eisenstatt said. “It’s not ideal. Time is a factor. And the way to solve this is a transplant. But consecutive consolidations” “are an available option.”

  “I’ve got to get on top of the insurance thing,” Oliver said. “I’m going to get that taken care of.”

  The doctor was quick, kept the discussion focused. “Let’s talk about time frame. It’s been seven weeks since you were diagnosed and started with induction. The normal waiting period between chemotherapies is about eight. Seven weeks is a bit early, but still in the ballpark.” With military precision, his marker tapped against the dry-erase board, two hard taps.

  “There are issues with your blood work.”

  The doctor spoke with a tone as even as was possible. “I took a quick look at your aspirate slides. Probably ninety-five percent of the cells look clean. But that five percent, they’re a question.”

  Alice’s eyes were shut in a way that meant she’d retreated into a mantra, one of her private worlds, and the sight was both a relief to Oliver and a little scary. Eggs of worry had hatched th
rough his stomach, spawning colonies at the base of his spine. Eisenstatt was saying that the structure of Alice’s leukemia cells was particularly complex: it was possible the cancer could go dormant for a time, then reemerge. He was saying those five percent cells might just be regular, small, dead, noncancerous cells, in which case everything was fine. “The other possibility”—he spoke as if he had no choice—“these cells are, in fact, cancerous.”

  A skilled palm wiped the board clean. Eisenstatt waited, checking whether Alice wanted to watch. “We have to be vigilant. We wait a few days with these cells, see how they mature, what happens when they replicate.” The doctor’s cheeks ballooned, he let out a breath, glanced at Oliver.

  “If the leukemia’s started to replicate,” he began, in Alice’s direction, “we have no choice. We have to deal with this. We’d be at an advantage in that we’re catching this early. Those first cells barely would have a chance to replicate. We go as aggressively as possible. I can’t say I’d call it a setback for your treatment. It doesn’t change any of our long-term goals. But what we’d need to do—” He raised the board. The marker tip squeaked on the slick surface:

  Alice had indeed opened her eyes and was looking at the board, at the doctor.