He remembered that after Amelia died, he had felt his days, no matter how cluttered with incident, to be thin, insubstantial. There was the physical world, in which one event dutifully followed the next, but there was no corresponding private space in which those events carried any meaning. It was not that he was empty; it was rather that he was too full, that he was afraid he would displace his feelings for Amelia—love and sadness and grief and resentment and a thousand other less definable but no less deeply experienced emotions—as though emotional investment was a zero-sum proposition. He felt he had exhausted his capacity for caring about what happened to him, but that could not be entirely true, because he seemed to care enough about this lack of caring to want to do something about it.
He decided that practicing medicine would be his solution. He had the notion that he would—should—spend the rest of his life helping strangers. The idea was that caring for other people would be a useful substitute for caring about himself. He was aware, even at age eighteen, that this was a cliché. But didn’t all clichés contain a measure of truth? Or was that too just another cliché?
He came to this decision near the end of the year he took off after graduating from St. Edmund’s. He deferred his college scholarship upstate to surf his way down the Pacific coast of Mexico, then south through Guatemala, El Salvador, Nicaragua, Costa Rica. He got around by bus and hitchhiking. It was a highly irresponsible trip—he didn’t have enough money to be spending even this little of it—but he found that people would let you get away with all kinds of irresponsible things while you were grieving, and nobody could question the depth of his grief. He and Amelia had been, as everybody knew, as close as a brother and sister could be. Not that he thought of the trip as getting away with anything. There was not much thought involved at all, only the compulsion to leave far behind the house on Beach 113th, this house that had somehow become smaller after the subtraction of one of its three inhabitants. He found himself running into his father in the kitchen, the living room, the mudroom, as though they were bats whose sonar had been scrambled. Amelia’s absence was itself a presence that filled the house more densely and concretely than any object, more sinuously than any smell.
He booked a flight to Mexico City, taking along the majority of his savings, cash he’d accumulated from various summertime jobs. After two months of rattling down washboarded Central American dirt roads in the beds of pickup trucks, of sleeping in hostels and on the beach, of surfing nearly every day, pummeled by sun, pickled by salt, Simon ended up in San José. He rented a room in a Holiday Inn for a weekend, pulling shut the blinds and cranking up the air-conditioning. On the bus ride into the city he could feel a sickness welling up within him, and it was there, in that anonymous hotel room, that it overflowed, a furious fever that ripped through his blood like an electrical current, shaking him with chills that lifted his body off the bed, soaking him with sweats that pooled in the hollow of his chest. He took the last pills in a bottle of ibuprofen, and then he was left with no more defenses, with nothing to do but wait the suffering out.
He squirmed on the foam mattress, the thin sheets and scratchy bedspread twisted around his body. The light at the edge of the blackout shades brightened and dimmed. He left the bed only to urinate in thick, deep-yellow streams and to fill a plastic bottle from the bathroom tap. Languidly, distractedly, he wondered if he might be fatally ill.
Sometimes he slept. But more prevalent than sleep was a half-waking haze, fever dreams full of gaudy abstractions—fiery pinwheels, metastasizing blobs—sometimes interrupted by a figurative intrusion: a teacher’s face, a palm tree, the inside of a subway car. These images lurched up out of the muck of his brain and then were quickly sucked back down again. Only once did an entire scene present itself. He had been woken by the sound of a moped backfiring. He closed his eyes and sank back down into the mattress, and then, as though a screen had been switched on, the clearest image of Amelia appeared behind his eyelids. She stood on one of the rock groynes that jutted out from the Rockaway beach into the ocean, wearing a purple windbreaker, her hair batted across her face by the wind. He was aware that he was standing on the beach, but the idea of his body seemed beside the point. The level of detail—glistening, granular—was beyond that of memories, beyond waking sight. He saw the stippled surface of the ocean. He could count each rock of the groyne, each container ship studded along the horizon. His attention did not have to be parceled out but could instead meet the entire breadth and depth of the scene at once. Amelia stood at the tip of the groyne, the ocean’s spray whipping across her legs. She looked back at him. Her face was many ages at once. She was a little girl; she was a teenager; she was the young woman she’d never become. Her face did not flash from one age to the next but rather accommodated all the ages, in the same space, at once. When she smiled, it was many smiles and also one.
Simon opened his eyes, and this vision of his sister remained so true, so perfect, that he was sure for a moment Amelia was there in the room with him. Or rather, that the dim hotel room was itself unreal, an illusion, and the beach was what was real, the beach and the ocean and Amelia, and he was the visitor, the apparition. As though he had died and Amelia were still alive. He struggled to sit up in bed, the force of the vision and the hot weight of sickness grinding down on his body. The fever broke a few hours later. The next day he used the last of his money to buy a plane ticket home.
It was within a month or two of his return that the idea of becoming a doctor first occurred to him. He couldn’t say when he initially thought of it—maybe during a conversation with his father or while watching some medical drama on television—but once he’d taken hold of the idea, he could not let it go. It was as though he’d always been working toward this goal without knowing it. He enrolled at the SUNY campus upstate the following fall and began taking premed courses. During his four years there, he passed all his requirements, not at the top of the class, but far enough from the bottom. He studied for the MCAT and did well enough on that too, and eventually he was accepted to a middle-tier medical school on Manhattan’s Upper East Side.
He rented a one-bedroom apartment on East Ninety-Third Street, near York Avenue, not too far from where he and his father and Amelia had lived before moving to the Rockaways. Michael visited the apartment and noted the doorman, the elevator, the views onto the river, before wondering aloud at its cost. Simon lied, undershooting the monthly rent by $500. It was the summer of 2007, and the cost of things seemed malleable, practically beside the point. You only had to wait and whatever money you had now would surely multiply, like self-dividing amoebae, so why stress over such things? Simon took out $45,000 in loans for school and spent his savings from four years of part-time work at the campus bookstore on rent and prescription drugs—mostly Valium and Klonopin and Ambien—which were delivered to his new apartment by a baby-faced NYU freshman.
He didn’t try to make friends at medical school; it happened only once and by chance, with a woman named Katherine Peel. She was black haired and pale skinned and five years older than him, a large woman who wore her largeness easily, sexily, as though it were a flattering dress she’d chosen for herself. Simon thought they understood each other immediately. He would have said their friendship was built on the platform of a shared pessimism, and on a shared response to that pessimism, which was to work obsessively hard against it, not in the hope of changing the world, or themselves, for the better, but instead out of a perverse personality defect in which despair and industry were inextricable. They thought this attitude would serve them well in their future residencies in the public hospitals of New York City, where good work had little to do with optimism. For Simon, it was as though rubbing against a surface as rough as his own had scraped away a layer of dead psychic skin, and he felt, briefly, in more direct contact with the world and with himself than he had since Amelia died.
• • •
THE night before he officially withdrew from medical
school, he met Katherine at a bar near her apartment in Murray Hill. He drank too much that night, a sloppy cascade of whiskey and beers and more whiskey. He talked about how much he missed Amelia. He talked about his father, how he would never be able to tell him he’d left school, how he was too ashamed to ask him for help with his loans. He was aware, even through the enabling scrim of alcohol and self-pity, that his performance was bathetic, ridiculous, and that Katherine’s response—to take him back to her apartment so he could drink himself the rest of the way into oblivion in private—was the correct one.
And so suddenly there they were, in her clothes-choked studio on East Twenty-Ninth Street, two glasses of terrible Spanish red wine and a pile of red capsules on the coffee table in front of them, Katherine explaining that the drug was the current hotshot painkiller in clinical trials, and she couldn’t tell him how she’d gotten her hands on it, and it wasn’t like the dirty opioids, and the word was that if you snort it, you’re treated to the most delicious pharmaceutical high this side of morphine, and did he want to try it?
Yes. Yes, he did.
Katherine leaned over the table and cracked open two of the capsules and prepared the lines, her hair, dyed to the bluish-black shine of crow feathers, falling across her face. The contents of the capsules resembled dried clay, and the sinus burn was incredible. Nothing happened for a moment, and then a warmth blossomed at the back of his skull and slipped down his neck, spreading outward through his blood with the slowness and sweetness of maple syrup dripped onto his tongue.
He leaned back in his chair and blinked at Katherine.
She gave him a dopey half smile: “I think we have a winner.”
He nodded, lit a cigarette. He drifted away for a moment, closing his eyes and following the thin trail of heat down into his lungs.
He’d been called in front of the med school’s disciplinary board that afternoon. He’d arrived expecting to be excoriated and then expelled; instead, they offered him a one-semester suspension and a psychiatrist. They wanted to talk about his feelings. He sat in his chair at the end of a long, polished conference table and blinked at the cluster of gray heads at the opposite end. A woman with hair the color and texture of steel wool sat at the head of the table, chairing the committee. In a kind voice, she asked whether he considered the school’s opportunities for psychological outreach and support to be sufficient or, perhaps, too limited, either by time constraints or, possibly, by the medical culture itself. He said he wasn’t sure. He asked them why they thought he might benefit from psychological outreach. There was silence from the far end of the table; then one of the doctors said that if Simon wanted to offer an explanation for his actions in the anatomy lab, they’d be happy to hear it. The woman at the head of the table shot the speaker a warning look. “We don’t expect our students to be machines,” she said. “We understand that the stresses of our program can manifest themselves in a variety of ways.” She told Simon that the school would be able to roll over his spring semester loans to the following fall on the condition that he enter into their psychological counseling program. He understood that an answer was expected of him. He already knew he wasn’t coming back, but he said he’d think about it. The committee members shifted in their seats as though a foul smell had wafted through the room. He waited for somebody to say something more, and when nobody did, he asked if he could leave.
“So, what are you going to do?” Katherine asked, pulling him back into the room. “I’m sorry.” She waved a languorous hand as though to disperse her words. “We don’t need to talk about this now.”
“It’s okay,” he said. “I don’t know yet. Lab tech maybe. Medical consultant.”
She nodded, as though she believed he was already considering these jobs, as though he had any sort of a plan yet. “You’ll have weekends, vacations. Time for other people. I’ll be jealous.”
“Of what?”
“You know. Your social life.”
But of course she wouldn’t in any way be jealous. Why should she be? There wasn’t any aspect of failure to be jealous of. And, anyway, he currently enjoyed no social life to speak of, his isolation first self-imposed then self-perpetuating. He didn’t see that changing simply because he was going to drop out of medical school and have some free time on his hands.
He moved from the chair to the couch next to her, bent over the coffee table, and snorted another line. The drug hit him faster and stronger this time. He was pinned back against the cushions by the heel of a firm yet gentle hand. He reached out to touch Katherine’s knee, feeling the denim grow warm and damp under his palm. She didn’t move her leg or push his hand away. The air in the room grew thick, tropical. He looked over at her. Her face was tilted away from him, her eyes half-closed, her lips half-smiling. With an enormous amount of effort, he lifted his hand from her knee to her neck, to the smooth skin there, white as bleached bone. She turned to him; he leaned into her. Her lips were hot and dry, and she let them rest against his for a few moments. Then she gently took hold of his shoulders and pressed him back into the couch. “No,” she said, simply and not unkindly. She stood up and disappeared behind him, returning with a blanket. “Sleep here.” He allowed himself to be guided into a prone position, allowed the blanket to be spread over his body. It felt good to be taken care of like this. She turned out the lights, and he heard rustling and then a sigh as she climbed into her bed on the far side of the room. She’d left for class by the time he woke up the following morning. When she called him next, a week later, it was to say she thought she might have found him a job.
• • •
HE’D gone into his interview with Health Solutions knowing only what Katherine had told him, which wasn’t much. Peter DaSilva was a childhood friend of hers from Riverdale, in the Bronx. She’d been close with his little sister; he’d been the obnoxious older brother, teasing and pranking his sister’s friends. A big mouth, the neighborhood smart aleck. He was a natural hustler, she said, a schemer from birth, the kind of kid who sold loosies in the high school locker room and crafted fake IDs on his family’s desktop. Early in his adult life, he’d discovered the health-care industry to be fertile ground for a wide variety of scams and side deals. He’d been, officially, a pharmaceutical sales rep, a health insurance consultant, a hospital administrative staffer, but he was now, in his midthirties, involved in “organ transplant consulting services” that “weren’t totally legal,” and he was in need of someone “discreet” with a “decent knowledge of medicine.” Katherine had helped DaSilva out a bit during the company’s first year—meeting with potential clients mostly—but his business was expanding, and he needed somebody more committed. Now that she was in med school, she didn’t have the time to spare.
They’d met at an Irish bar in Bay Ridge. Simon still didn’t know if this was near where DaSilva lived or if the location had been chosen randomly or even as an intentional misdirection. (Peter would prove remarkably adept at keeping the details of his life outside Health Solutions and Cabrera hidden from Simon, and he didn’t probe for information about Simon’s private life either. Simon recognized this as a smart business decision: the less they knew about each other, the harder it would be to link them in any investigation. It was possible, too, that DaSilva simply didn’t have much of a life outside of his two jobs, that there simply weren’t enough hours in the day.) It was early afternoon, and they sat at a table by the front window, milky January sunlight spilling across their laps, a slice of the Verrazano’s underbelly hanging high in the window’s upper corner. DaSilva—calm and terrifically fat, sipping daintily at the head of a pint of Guinness—seemed most concerned with establishing that Simon wasn’t going to try to return to medical school. He needed “continuity.” It was not, he said, the kind of job you try out and then drop right away if it doesn’t agree with you. Simon told him he couldn’t go back to that school even if he wanted to, and this seemed to be good enough.
When D
aSilva explained what Health Solutions did, he made the company sound like a charity or an NGO, like Planned Parenthood or Meals On Wheels: an organization that provided a morally necessary service neglected by traditional institutions.
“Who are we,” he wondered, speaking as one reasonable person to another, “to tell people what they can and can’t do with their bodies? If we’re honest with people, and they’re willing to pay for a surgery and accept all its risks, who are we to tell them they can’t spend their money like that?” He waited for an answer.
“I don’t know,” Simon said. And he didn’t.
“I work in a transplant unit, okay? That’s my ‘legitimate’ job, I guess you’d say. I’m a coordinator. I try to put the pieces together for donations. I try to get very sick people the organs they need to live. I see, firsthand, my patients dying because they can’t get access to a kidney or a liver fast enough. Not enough young, healthy people crashed their motorcycles or shot themselves in the head this month, so, sorry, no liver for you. If nobody in your family’s a match or healthy enough to donate, you’re likely shit out of luck. It’s a waste, and I’m sick of it. So those are the recipients. As for the donors, who are we to tell people they can’t sell something that’s already theirs?” He leaned in with the fervor of a true believer, or at least a very convincing facsimile of one. “Isn’t it condescending to talk about exploitation, as though these donors—rational, adult human beings—can’t make decisions for themselves? Why should we restrict their ability to better their lives? They know the risks. We don’t mislead anybody. For Christ’s sake, they come looking for us.”
Simon wanted to tell him that the further prosecution of a moral argument wasn’t necessary. He didn’t know precisely where he stood on the issue of legalizing organ sales—he’d never had a reason to consider it before—but he did know that he harbored no opposition strong enough to prevent him from taking the job. He needed money, and he needed it quickly; if he could make that money while helping seriously ill people, then all the better. Yet DaSilva seemed to enjoy playing the provocative ethical philosopher, so Simon let him talk, nodding and frowning at the appropriate points. The whole time, he wondered how DaSilva could trust him with all of this information.
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