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“Give her,” Oliver said. “Give her to me.”

Taking the baby, he said,
“You’re a good girl, okay, there, there,”
and started away from Alice, away from Eisenstatt, along the empty side of the exam room. “I’ve been dealing with Unified.” His voice was resigned, more than a little defensive. “It’s not a big deal, a bunch of red tape, mostly. But trying to get people to read the facts that are right in front of them, don’t ask me why—it’s really not worth getting into here.”

Eisenstatt had the expression of a judge who may have sympathized with the defendant but had been through the courtroom sob story more times than he could count. “By necessity there’s a wall between medical and billing.” His arms folded over his clipboard and held to the middle of his chest. “I hate insurance companies.
Hate them.
We’ll do what we can.” He asked the nurse-practitioner to put Oliver and Alice in touch with the hospital’s social services liaison. She could act as a mediator and help with financial aid forms, if it came to that. “Make no mistake,” said Eisenstatt. “You have to get this settled. Getting you to a transplant is the only option here.”

Whitman Memorial, 1220 York Ave., 4th floor, Hematology/Oncology (interview), N.

They’d been friends a long time now, living down the hall from one another for upwards of twenty years. This friend of hers, a single mom. She used to drop the boy off whenever, then she lucked out and got herself remarried. She scooted out of the city and up to the burbs, Rye: her and the new hubby and her son. Kid was a bright boy. Salutatorian of his high school, even earned a free ride to someplace down south, one of those states with traditions of Confederate flags and really good barbecue. When that child got down there, something happened—his heart got smashed, or being away freshman year was too much, maybe he just straight bugged. It wasn’t uncommon—a kid is alone, the year goes on and the pressure mounts, he burrows deep inside his own head. This young man became withdrawn, wouldn’t come out of his dorm room. Got so bad he had to leave school and head north. His mom kept wanting to know what was wrong. All he said:
I had to get out of there.

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

“L
ie 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 sure 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

I
T 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.