The man was quiet for a long moment. "Yes," he said. "At somebody. Not you."
Lucas accepted this. It was better than being lied to. He finished the bread and folded the blanket tighter. The man stood up again and came back with a roll from the bread box — a soft one, like the ones in Lucas's pocket — and set it on the table in front of him.
"For later," the man said. "In case you're hungry."
Lucas stared at the roll. His right hand was still in his sweater pocket, touching the other two. He picked up the roll from the table and, after a moment, put it in the pocket with them.
"Good night," the man said.
"Good night," Lucas said.
He went back up the stairs with three rolls in his pocket and the blanket around his shoulders, and in the too-big bed he fell asleep before he could count the sounds of the house.
Chapter 7: What the Heart Takes
Dr. Simmons had been Arthur's cardiologist for eleven years, ever since Margaret, and he had the bedside manner of a man who had delivered every possible kind of bad news and learned, along the way, that plain words were the only mercy.
"Familial cardiomyopathy," he said. "The heart muscle thins and stretches. It can't pump the way it should. In your wife's case it was — in her case, it moved quickly. In your daughter's case it moved more slowly, but it moved."
They were in the study. Priya Raman sat across from Arthur with a folder open on her knees. She was forty-five, precise in everything, and she had spent three days getting Caroline's medical records from two hospitals and a clinic in Queens — a clinic, Arthur had learned, that took patients on a sliding scale and kept its waiting room chairs bolted to the floor.
"Walk me through it," Arthur said. "All of it. I don't want the gentle version."
Simmons glanced at Priya, who nodded once. "She was diagnosed four years ago," Simmons said. "About a year after her husband died, if I have the dates right. The echocardiograms show a steady decline — the left ventricle enlarging, the ejection fraction dropping. By this spring it was below twenty percent. Normal is fifty-five to seventy."
"What does that mean, in plain words."
"It means her heart was doing a third of the work it should have been doing, and getting weaker every month. It means walking up a flight of stairs would leave her breathless. It means at the end, her body was drowning itself — fluid building where it shouldn't, because the pump couldn't keep up."
Arthur looked out the window. December light, thin and white. "And the surgery."
"She was a candidate for a transplant," Simmons said. "That's the truth of it. Medication could only hold her for so long. But a transplant evaluation requires — among other things — proof of insurance coverage, a stable address, a support network for recovery. She had none of the paperwork. And the waiting list—" He stopped. "The waiting list doesn't care about any of that. But getting on it does."
Priya turned a page in the folder. "She had an emergency room visit in March. Fluid in the lungs. They stabilized her and discharged her with a prescription she couldn't fill. The pharmacy record shows it was never picked up."
"How much," Arthur asked.
"Four hundred and twelve dollars," Priya said quietly. "A month."
Four hundred and twelve dollars. Arthur had paid more for a bottle of wine last Tuesday. He had paid more for the flowers at the gala. He sat with the number and felt it take up the entire room.
"She kept working," Simmons said. He was reading Arthur's face and choosing his words. "The clinic notes mention it. She was a waitress. On her feet, carrying trays, until — until she couldn't stand for a full shift anymore. Then she went to part-time. Then the notes stop."
"When did they stop."
"October. Five weeks before she died."
Arthur closed his eyes. Five weeks. She had died alone in that apartment — no, not alone, Lucas had been there, Lucas had found her or called someone, and Arthur had not asked him, would not ask him — and seventeen days later Arthur had stood in a ballroom in a tuxedo while a quartet played, and had known nothing.
"Could she have been saved."
It came out flat. Not a question, exactly. An accounting.
Simmons was quiet for a long time. Arthur had learned to fear the pauses of honest men.
"I don't know," Simmons said at last. "That's the honest answer, and I know it's not the one you want. With money — with early intervention, with the right medication from the start, with a transplant evaluation begun two years ago — her odds would have been enormously better. Enormously. But this disease is a thief. It took your wife at fifty-one with every advantage you could buy her. It might have taken Caroline anyway. It might not have. I can't give you the other road, Arthur. Nobody can."
Arthur nodded. He appreciated, in some distant way, that the man had not lied.
"Is it—" He stopped. Started again. "The boy."
"I'd like to screen him," Simmons said. "Soon. The gene doesn't always pass, but when it does, knowing early changes everything. We monitor, we treat, we act before there's a crisis. That's the whole game now — time."
"Do it," Arthur said. "Whatever it costs. Whenever. I don't want to hear about insurance."
After they left, Arthur sat in the study with Priya's folder. The medical records were copies, impersonal, stamped and initialed. He read the March ER discharge summary twice. Patient counseled on medication compliance. Patient states she understands. He imagined her in the bolted-down waiting room chair, understanding perfectly, choosing between four hundred and twelve dollars and the rent and the boy's shoes.