“If I get to see Adam first, yes.”
She squeezed my hand. “Well, that’s still the plan.”
SIXTY-NINE
The taxi took us into the city, but not toward the familiar territory of the Yale campus. Lizzie still wouldn’t reveal our destination. My heart plummeted from my chest to my toes when I realized that the cab was rolling to a stop on York Street outside a building I recognized from a previous visit I’d made with Connie back when he was—barely—ambulatory. We’d stopped by to visit a philosophy department friend of his who was recovering from prostate surgery.
Involuntarily, I said, “No.”
Lizzie threw some bills at the driver and pulled me out of the cab onto the sidewalk. Outside the front entrance. She held my face in both her hands and said, “I said he needed you. I wasn’t lying. What do you know about acute liver failure?”
Above her head I could read the sign on the outside of the building. YALE–NEW HAVEN HOSPITAL.
“Oh my God. Oh my God. Where is he? He’s here?”
“What do you know about acute liver failure?” she repeated.
“Nothing,” I said.
“I’m going to call you ‘Doctor’ once we’re inside. Do you understand?”
Inside the Yale–New Haven Hospital.
“Yes,” I said.
“You’re a physician, a colleague of mine from out of town. It’s natural for you to feel out of place.”
“Okay.”
“The less you say, the fewer mistakes you’ll make.”
“Yes,” I said. I was having trouble putting one foot in front of the other. Falling on my face would certainly be one of those mistakes.
We’d arrived near morning shift change and the elevator lobbies were full of staff waiting to head up onto the patient floors. Lizzie held me back from the group. She said, “Wait.” Two cars arrived simultaneously a moment later. The lobby emptied. “I think we’re about to get lucky,” she said. “It’s a good sign.”
I wasn’t feeling lucky.
A third elevator arrived. We stepped on alone and waited for the doors to close. Ever so slowly, they did. We had the car to ourselves.
Little-known fact: Hospital elevators are the slowest moving vehicles on the planet. They are the sloths of vertical travel. Usually I found their torpidity frustrating. That day, though, the languid pace gave Lizzie time to tell me a story I was desperate to hear.
She said, “Adam was dropped off at the emergency room two days ago by a Hispanic man. I’m guessing that it was your brother’s friend, Felix. He told the triage nurse that the kid’s name was Adam, that he’d been sick for a couple of weeks but had gotten much worse in the past twenty-four hours. He said that he was going back out to his car to get the kid’s papers and things. He never came back inside. Adam had no ID with him, no insurance info. Nothing. He presented with fever, obvious fatigue, nausea, vomiting. Severe confusion. It took the ER docs a few hours to identify what was going on. Your son is suffering from acute liver failure.”
“From what?” I asked. I was baffled. And I was argumentative. I tried to counter her words, to change the reality. “He’s never had liver problems.”
The truth was that I didn’t really know that. I’d never asked about my son’s medical history. God.
She recognized the desperation of my tactics and lowered her voice to slow my escalation. “I don’t think they know the cause. It’s not always simple to identify the etiology. Most likely it’s something infectious—maybe viral hepatitis. But it could be toxic—an overdose of Tylenol could do it. Or it could be something idiosyncratic and metabolic. It could even be a complication of something cardiac and chronic that’s previously gone undiagnosed.”
“What’s your fear?” I asked. I could tell she had one.
“Worst case? If it’s fulminant viral hepatitis, it could be … critical. Very serious.”
Some of her words made sense. Some didn’t. “Fulminant” was one of the words that didn’t. My medical-technology background failed me; all I could manage was to ask her for some variation of the same assurance I’d asked for three times since she held my face in her hands outside the cab: “He’s okay, though? He’ll get through this?”
She answered the same way she had the other times. “He’s very sick. Prepare yourself. He won’t look well.”
“It might not be him up there,” I said. “There are lots of Adams in the world.” I wanted it not to be him.
I want it to be him.
“It’s him,” Lizzie said.
It’s him.
Seconds before the elevator doors opened, she said, “We don’t have hospital IDs so this is going to be tricky. Improvise with me. Confidence and arrogance. Ready?”
“Yes. Where are we?”
“Intensive care.”
“Oh shit.”
“Some advice?” she said.
“Anything.”
“If confidence fails you, rely on arrogance. Double up if you need to.”
Lizzie marched to the sprawling nursing station that was separated from the patient rooms by a wide corridor. She stepped behind the counter as though she’d been there a hundred times.
After perusing a chart rack, she selected a plastic-jacketed chart with the name “Adam Doe” written in block letters on a piece of tape on the front.
“Those labs back yet?” she asked the unit clerk, who was gazing back at Lizzie over her shoulder. The look from the clerk was tired and mostly bored, but partly curious. She was wondering if she knew Lizzie. But it was the end of her shift and she wasn’t sure if she really cared if she knew Lizzie.
Finally, in an uninterested voice, not a suspicious one, the clerk said, “The blood just went down ten minutes ago.” Left unsaid: You should know that, bitch.
Lizzie sat down at a computer and went online. Within seconds the screen was covered with columns of lab values. She sent a couple of pages to the printer, picked up a phone, and punched some numbers. “This is the ICU. I need an ETA on the new liver numbers for Adam Doe … Yeah … I know they’ll be in the computer when they’re done. The problem is they’re not … Okay, you’ll do that now? … Promise? … Great, thanks.”
She grabbed the pages out of the printer tray, stuffed them into her bag, and said, “Come on, Doctor.” After a momentary brain cramp, I realized she was talking to me.
I followed her from the nursing station across the hall into a vestibule that led to Adam’s room.
“Gown and gloves. Do what I do,” she whispered. She was pulling a pale yellow gown over her clothes.
I started to do the same. But I couldn’t take my eyes off a teenage boy, suddenly visible through the window in the center of the door.
It was Adam. My Adam.
He was yellow. Not the same yellow as the gown I was holding. His yellow was more mustard, less lemon. God, he looked sick.
Lizzie grabbed my wrist. “Focus,” she insisted. “Do what I do. Come on. Act like you’ve been here before.”
Somehow I managed to pull the flimsy gown over my clothes and snap some latex gloves onto my hands.
She handed me a face mask. “Just hold the mask up to your face. Don’t bother to tie it.” She modeled how she wanted me to do it.
I did what she did.
“You’re his doctor, not his father,” she said.
Wrong.
We walked into the room and stood beside Adam’s bed. She picked up the clipboard hanging at the foot of his bed to check his ins and outs, and then started checking the labels on the infusion bags hanging above the IV pump. I read his blank, yellow face. It took every bit of self-control I had not to crawl into the bed and hold him.
He was hooked up to fifty leads, surrounded by a dozen monitors.
Lizzie said, “They’re giving him neomycin to treat encephalopathy. The chart said there was no edema so far. That’s good.”
What? “Edema?” I whispered, parroting her. The word was, of course, familiar, but I couldn’t p
ut a definition to it. I should know what that means, I thought. I should.
“Swelling in his brain. It would be a serious complication.”
Shit. “Can he hear me?” I asked.
“I doubt it. No.” She paused. “Maybe.”
“I need to tell him things.”
The intercom sounded from a location near the door. I almost jumped out of my shoes.
“Doctor? Those labs are back,” the unit clerk said in the exact same bored voice she’d used earlier.
“Thank you. I’ll be right out,” Lizzie said. To me, she whispered, “I’m going to go look at the labs. You stay here while I do. Remember, you’re a doctor, not a father. People don’t know you; they’ll be watching.”
She took a step toward the door before she stopped and turned back toward me.
“What I was fearing? It’s happening. Adam needs a transplant. Without it, he could die. They’re looking for a donor liver.”
“What?”
What?
“He could die without a new liver.”
“When?”
“Soon.”
“What soon? Next week? Next month?”
“Sooner,” she said. She stepped from the room.
SEVENTY
Did I know right then?
Not in any complete sense. Not really. I couldn’t have explained it. I couldn’t have choreographed the next few steps. But I had a premonition about what was coming and I could have predicted what the set, absent a few props, would look like when the curtain finally came down.
I thought I knew the “if” even if I didn’t know the when.
Or maybe I knew the when, but I didn’t know the if.
Everything was backward.
My son was dying.
That was never part of the plan. That was never part of the deal with the Death Angels.
Not at all.
But I was suddenly serene. For the first time in a long time, I was serene.
Adam listened, or he didn’t, as I told him everything I could squeeze into the three or four minutes I had alone with him in that hospital room. I told him about the Death Angels and about intimacy and about cowardice—mine—and about love and Thea and Cal and Haven, and about Lizzie and about me and how I thought I’d changed and how he was a big part of how I’d changed, and why I’d changed, and I tried to explain why I’d been able to change.
I told him I was sorry and I asked him for forgiveness.
I told him that there was a psychologist in Boulder named Alan Gregory who would fill in all the details I would never get a chance to tell him.
I told him I loved him.
“You have to live,” I implored him. “None of it makes any difference if you don’t live.”
“We should go.”
Lizzie was behind me. Her voice was at once firm, and soft. I hadn’t heard her come back into the room. “It’s too risky to stay here any longer. As soon as shift change is over or one of his docs shows up, we’re screwed. We have to go.”
“Can I kiss him?”
“No.”
“Shield me,” I said to her.
She stepped forward. I leaned down, pulled the mask from my face, and kissed my son on his yellow cheek and then once, dodging tubes, on his chapped lips.
His lips tasted of glycerin.
“Good-bye, Adam,” I said.
Lizzie was in tears as we left the room.
Me? I was a wreck. I was the man I thought I would be had I hit one of those two trees at the bottom of that chute in the Bugaboos. Lizzie could’ve transported me back out of the ICU in a thermos.
I felt pain unlike anything I’d ever experienced in my life.
But I was serene.
SEVENTY-ONE
We took the stairs down to the lobby.
“I’m sorry,” she said. “I’m so sorry.”
She said it more than once. How many times? I was crying too much to notice.
I wiped away some more tears and nodded.
“I want to find Felix,” I said. “Maybe he can tell me something. You know, what happened.”
“Sure,” she said. We were almost down to the first floor. “That shouldn’t be too difficult.”
It was all so banal. It was just conversation. We both knew that Felix had no answers that would make any difference.
I turned toward the main exit, the one we’d used to enter the building. She tugged me in another direction. “No, this way,” she said.
I followed her down some corridors to the Emergency Department. “Let’s go out this way instead,” she said. “Just in case.”
In case the Death Angels are waiting. Watching.
Aiming.
I felt no fear at the thought. None.
Outside, the morning air was chilly. Not Ridgway chilly. Connecticut chilly, with a biting wind off the Sound, which was Ridgway chilly to the n th. Twenty yards or so down from the ER door, but still under the long overhang that protected the entrance, Lizzie hopped ahead of me and sat on the wide rear bumper of an ambulance that had backed up earlier to deliver a patient. She patted the space next to her on the bumper. I sat, too. Instantly, I could feel the cold steel through my trousers.
“They may not get him a liver in time,” she said. “You have to know that. He’s very sick, and it’s hard to get organs on short notice. He could get too sick, too fast. Acute liver failure can be a runaway train.”
I tried to use logic as a salve. “He’ll be a priority, right? He’s young, healthy. That’s how it works? He’ll be a priority, won’t he?”
She pulled out a cell phone and punched in a number. Seconds later she said, “ICU ward clerk, please.”
A moment later I heard the sound of the clerk’s bored voice. She said, “ICU.”
“I’m about to give you the identity and contact information on Adam Doe, the teenager with liver failure. Ready?” Lizzie stated Adam’s name, Bella’s name, address, and phone number, and then my name, address, and phone number. She provided his student information from Brown and dictated his health insurance coverage information. She surprised me most by then reciting a concise version of my son’s medical history. She knew his vaccination status and knew he’d had pneumonia when he was eight. She knew he was allergic to sulfa. I didn’t know any of that. “You get everything? Good. No questions? Now you need to call everyone stat, starting with his docs, and then his parents, and let them know what’s going on. Get someone else to alert the New England Organ Bank, and the United Network, and make sure that they’re up to speed on all this. Give the transplant team a heads-up, too. Get an OR ready. Do you understand what I’m saying? This kid needs a liver. Go get him one. He’s out of time.”
She hung up.
To me, she said, “He was already a priority. Maybe he’s more of one now. But there are no guarantees. None. A lot depends on how fast he gets sicker.”
“The hospital will call Thea and Bella?”
“Yes.”
Thea would call LaBelle. LaBelle would call Mary. Mary and Trace would fly Thea to New Haven. They’d pick up Bella in Cincinnati on the way east.
Lizzie hugged me. I held her.
We both cried.
But the tears didn’t chill my flesh.
I was feeling the if.
It was warming me like a hot wind blowing from the south.
PART II His Story
SEVENTY-TWO
Did either of them—my patient, or the woman he called Lizzie—know they were being recorded on a surveillance camera as they sat side by side on the back bumper of that ambulance outside the Emergency Department of the Yale–New Haven Hospital?
I’ve wondered a lot about that. Maybe she knew. Lizzie.
I doubt that he’d given it a thought. By then he had too many other things on his mind.
But the surveillance camera was there, capturing all the events of the next few minutes.
I saw an edited version of the clip for the first time that same evening on CNN. I didn
’t see the entire footage for another couple of days. Not because it wasn’t available. It was available everywhere, had been downloaded a gazillion times on the Web.
I didn’t see the entire footage for another couple of days because I couldn’t bring myself to watch it.
Their embrace on the bumper of the ambulance lasted for a long time. It was hard to tell who was more thirsty for comfort, but the poignancy of them holding each other, their bodies occasionally shaking from swallowed tears, was so intimate that it was painful to watch.
It was as though a camera had surreptitiously caught lovers coupling, and the footage was being played for all to watch on the evening news.
When they pulled apart—she let go first, not him—she reached up and held his face in both her hands and pulled him within inches of her. She spoke to him for most of a minute. As she spoke her right hand caressed his face, her fingertips edging up into his hair. Her left hand stayed perfectly still on his cheek, holding him.
At one point, she said, I think, “Now … is when.”
He didn’t say a word in reply. He nodded, though.
I’ve watched this part of the video at least twenty times, most of those times in slow motion, trying desperately to read the words her lips were forming. Dozens of Web sites blossomed with translations of her subtle lip movements. Each interpretation was a little different.
Talking heads argued about her mouthed words on cable news. Hearing-impaired specialists debated the esoteric art and science of lipreading.
I’m still not sure exactly what it was she said to him after she said, “Now … is when.” But whatever else it was that she was saying, he was nodding in reply.
Agreeing.
I’m certain, a hundred percent certain, that he was agreeing.
Enthusiastically agreeing.
When she was done speaking, and he had nodded one last time, I think she asked him, “Are you sure?”
And I think he said, “Yes.”
She sighed then. It’s easy to tell that she sighed. You can watch her fill her lungs with air—her mouth opens, her chest expands, her shoulders rise—and then she expelled all the spent gases out of her body at once.
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