She had created three concentric circles. The outer circle she rendered to look like wood grain, the next circle was made to look like rock, another like water, and in the center was the earth. It was astoundingly beautiful. “Professional” didn’t do it justice.
“Ruby, I’m speechless. I love it.”
“I’m so glad. It took me a while, but I think it came out great. What’s today’s number?”
“One hundred twenty-three thousand registered players.”
Ruby broke into a smile. “Forget acupuncture. You’re taking us to Beverly Hills, baby!”
“Last I checked, mortgage companies aren’t accepting future potential as a down payment on a mansion. I really need closer to a million registered players before I can start touting my rags-to-riches story.”
“I believe in you, John. I know it’s going to happen.”
I made a “Who knows?” shrug.
With a hundred thousand registered players, I should be rolling in the dough. Only, I didn’t charge people to play. I’d basically built FarmVille meets Minecraft. It’s an eco-conscious game, which takes longer to build a loyal enough following to start charging a fee. Like a lot of game designers, I make my money selling virtual items that enhance the game play. After expenses, I cleared about fifty thousand dollars, most of which got reinvested back into the business. In addition to Ruby’s tuition, we have other expenses to pay as well. Rent. Food. Bills. Insurance. All the usual suspects. Hence, no cable.
“I’m glad you like the logo,” Ruby said.
“I don’t just like it. I love it. It goes live tomorrow.”
“Good. I’m going to get something to drink before we start. Want anything?”
“No,” I said.
I watched her go. Hard not to. I felt like yelling out that I was the luckiest man alive, only Ruby didn’t believe in luck.
A few years back, Ruby hung a vision board on our bedroom wall. The vision board was a three-foot-by-three-foot corkboard, covered with a purple silk cloth—for prosperity—and decorated with images and words that conveyed our shared desires. Ask and the universe will provide, at least that’s what Ruby believed. I believe in relying on yourself to solve your own problems. The mountain has a cold and angry way of reinforcing that kind of thinking.
Still, Ruby pleaded with me to ask the universe to make One World a smash success. I thought it was silly at first, but I relented—Ruby’s hard to refuse, especially when pleading—and so I tacked up the logo of a prominent gaming blog onto the vision board. A few weeks later, I got a five-star review. Did I think the universe had answered my wishes? No, not in the least. Coincidence? Sure. Now, that’s something I can believe in. I have a degree in computer science from Boston University, so logic is the ruler of my world. Trusting in the universe is a heartwarming idea, but I’m a bigger believer in hard work, determination, and a sprinkle of talent.
A game designer needs to understand computers the way a general contractor must know all facets of building a house, which is why it took a team of people to put my game together, but now I manage the code and servers on my own. Anyway, the bloggers seemed to like the idea behind the game. Players are tasked with building the coolest, biggest, most awesome virtual world possible without pillaging One World’s limited resources. Oh, and you’ve got to do all this while battling marauding hordes of zombies, who come out only at night.
There was a time, not that long ago, I couldn’t muster the energy to get out of bed. I just lay there, hearing Brooks’s screams as he fell to his death. Dark years. Ruby plastered the vision board with every image of health and happiness she could find. Three weeks later, Ruby found a flyer for a local acupuncturist in the mail and urged me to give it a try. The results were so astounding that Ruby decided to quit her job as the in-house graphic designer for a finance company to concentrate on becoming an acupuncturist herself. I encouraged her to do it. We could squeak by on one income for a while. It’s amazing how far a few judicious cuts can take you.
Ruby returned and got her study materials together, but I wasn’t done trying to woo her into bed. I started rubbing the soles of her feet.
“Hmmmm,” Ruby said. “That feels nice.”
I removed Ruby’s cotton socks and dug my thumbs gently against ten years of jogging calluses. Ruby cooed some more, and I kept on massaging. I thought about the number—one hundred twenty-three thousand registered players—and couldn’t help but imagine how a million would alter our lives. I wondered if Ruby and I would start a family sooner than our current post-school thinking.
Brooks Hall would never have children, and I might. “Where’s the fairness in that, dear universe?” I switched from the right foot to massage Ruby’s left. My thumb traveled from the toes and finished at the heel. But my fingers brushed against something strange. A sensation that felt surprising to touch. I ran my thumb over the offending area again, and still again.
“Hey, the rest of my foot is getting jealous,” Ruby said, shaking it.
I raised Ruby’s leg and shifted position to get a better look at the underside of her foot.
“What is it?” Ruby asked. A touch of alarm seeped into her voice.
I went to the kitchen and grabbed the penlight flashlight I used to build or repair my computers. When I returned, Ruby was sitting on the floor cross-legged, examining the bottom of her foot. I got down on my knees and took a closer look with the penlight. Ruby’s eyes were wide, dancing nervously. I knew she hated when I went silent on her.
“What’s going on?” Ruby asked again.
“Have you seen this dark patchy area before?” I asked her. “Do you have any idea how long it’s been there?”
“I’m not checking out the bottom of my foot every day, if that’s what you’re asking. John, you’re scaring me.”
“I don’t like how this looks,” I said.
I had reason to be concerned. Mountaineering exposed climbers like myself to a greater degree of ultraviolet radiation. I had studied up on the latest gear, lotions, and trends for delivering maximum sun protection. I had also learned to detect the signs and symptoms of skin cancer—asymmetrical growth, ragged edges, nonuniform coloration, and a large diameter. The oddly shaped mole on the underside of Ruby’s foot, about the size of two pencil erasers, was far larger than the quarter-inch safety limit. What I didn’t know, and what Ruby couldn’t tell me, was if the area of concern had grown in size, and if so, how quickly it had evolved.
“John, you’re really starting to freak me out,” Ruby said, pulling her foot away from my lengthy and silent examination. “What are you thinking?”
I moved in close to Ruby, cupping her flushed cheeks in my hands.
“I think we need to call a doctor, just to be safe,” I said. I made sure my voice sounded soothing. “But I also think that everything is going to be just fine.”
Ruby looked me in the eyes and strained to smile.
We’ve been married five years, and we dated for an equal amount of time.
She could always tell when I was lying.
CHAPTER 2
“The cancer has spread.”
The doctor’s words hung in the air like an oppressively humid day, sucking up all the oxygen in the antiseptic examination room.
“The cancer has spread.”
This was the culmination of a three-week journey that had begun with Ruby’s first-ever visit to a dermatologist. The initial tests had come back positive for cancer—melanoma. Only we didn’t know how bad it was or how much it had spread throughout her body. We were referred to a dermatological oncologist, who scheduled Ruby for a CT scan. Then we had to wait.
Ruby sleepwalked through the days following her initial diagnosis. We simply couldn’t wrap our heads around what it really meant for our future. Make a checklist for a nervous breakdown, and we’d have all the symptoms. Panic? Sure. Crying easily? Of course. Upset stomach? Exhaustion? Check and check. We were trapped in a brutal, unrelenting anxiety loop.
�
��Shit, shit, shit!” Ruby would sometimes blurt out. “Shit, shit, shit!”
Dr. Lisa Adams, our pale-skinned dermatological oncologist, perhaps a decade older than Ruby, revealed the results of the CT scan without being overly emotional.
“I’m afraid there are some suspicious nodes in the groin,” Dr. Adams said to Ruby.
In my mind “suspicious nodes” had the ring of a death sentence. Ruby gripped my hand tighter. The diagnosis threw me into a dull fog. I was too numb to process everything, and much of what Dr. Adams said next passed right through me.
“Unfortunately, the cancer has spread. . . . The melanoma appears to be stage three. . . . We have the results of the biopsy from the growth on your foot. . . . Cancer is caused by a BRAF gene mutation . . . treatment available . . .”
Her words tumbled about my head. I sensed the coming hurricane of information overload that would carry us off to a foreign country where we didn’t speak the language—an alphabet soup of terms, treatments, and genetics.
“I’m twenty-eight years old,” Ruby said to Dr. Adams. “I’m too young to have stage three cancer.”
“I wish that were the case, Ruby,” Dr. Adams said. “I really do.”
The cancer has spread.
“Am I going to die?”
“This is a treatable condition,” Dr. Adams replied. “We’ll start the drug treatment first and gauge how well the nodes are responding. If we do get a response, then the nodes have acted as a ‘marker’ that will help us determine how responsive to the drug you’ll be. If you don’t respond to the drugs, then a surgical procedure called a node dissection becomes essential. Surgery would likely follow even if you do respond completely to the drug, as there would likely be some microscopic cancer left in the nodes. Does that make sense?”
If it did, Ruby didn’t say. She clearly had other things on her mind. “What’s the survival rate? Please! Am I going to die?” Ruby’s last question was punctuated by a choking sob.
I embraced my wife, shuttering my eyes to hold back my own flood of gathering tears. Ruby needed me to be strong for her, present and positive.
We were talking about the vacation we going to take once we had this thing licked. Ruby was hinting at starting a family. Now she’s asking about living—survival rates! It’s not fair. No, this isn’t happening to us. It’s not real. This is not happening!
“I love you,” I breathed into my wife’s ear.
God, I love you so much.
Adams waited for the right moment before answering Ruby’s questions.
“We’re going to do everything we can to make sure that doesn’t happen,” said the doctor. “And I’m going to help you every step of the way. The tough part is that I can’t beat your cancer for you. We’re going to have to battle this together.”
“How did it progress so fast?” Ruby asked. “Can’t we just cut it all out? How did I get it on the bottom of my foot? What’s the drug treatment?”
Dr. Adams listened intently to Ruby’s rapid-fire questions. She studied everything about Ruby’s gestures, vocal intonation, and expressions, much like a psychotherapist conducting an assessment of a new patient. I figured that in addition to answering Ruby’s specific questions, Adams needed to ascertain how much information to share and what should be revealed in future discussions.
“Unfortunately, there is no curative therapy for most metastatic cancers—that is, a cancer that has spread to other parts of the body.”
“What do you mean by no curative therapy?”
“We need to focus on the containment strategy I outlined for you.”
“Why?” Ruby asked, pleading really. “Why is this happening now?”
“I wish I could say, Ruby,” Dr. Adams said. “Most skin cancers are not hereditary, but there are certain cases where a parent with a certain type of skin cancer increases the average risk of getting a cancer yourself. Still, I would lean toward ruling out familial melanoma—”
“My mother basically lives in the sun,” Ruby said. “She’s never had any problems.”
“But I couldn’t claim that as fact,” Dr. Adams said, finishing her thought.
Adams referenced Ruby’s file. I suspected she was double-checking the family history—what little Ruby knew of it, anyway. In those pages, Dr. Adams would find reference to a father who died of a heart attack when Ruby was eleven, a few uncles and aunts who suffered a variety of ailments, none of which were melanoma or cancer of any kind.
“Even with further testing, I can’t promise that we’ll be able to figure out if a specific environmental factor is to blame for the mutation. And speaking honestly, the why isn’t as important right now as the what, meaning what we are going to do to fight your cancer?”
“I want you to tell me everything about my cancer,” Ruby continued. “Don’t hold back. I mean it. I want to know it all.”
Ruby sounded definitive. I interpreted Dr. Adams’s change of expression as one of pleasant surprise. She didn’t know Ruby’s fighting spirit. If one thing gave me hope, it was my wife’s tenacity and willpower. Both, I believed, would be as healing as the cancer was deadly. Ruby could get a Christmas present in summertime and wait six months to open it. She can keep the one-cookie promise, and I’ve never once heard her hit the snooze button. Yeah, she’s got willpower, all right.
Dr. Adams spoke for fifteen uninterrupted minutes. She explained the gene mutation in greater detail and walked us through the recommended course of treatment. She spent some time talking about the node dissection and what Ruby should expect after her surgery. We listened with rapt attention. My head would occasionally nod my understanding, while Ruby’s didn’t move.
“The drug therapy I’m going to recommend has been highly effective in treating your type of cancer.”
“What’s the survival rate?” Ruby asked again.
Somehow, the doctor managed to skirt that question. “I really can’t say definitively,” Adams replied.
“Best guess,” Ruby said.
“A lot of variables go into factoring survival rates.”
“The number, Doctor, please,” Ruby said.
I could tell Dr. Adams swallowed this part of her job like bitter medicine.
“We think of survival rates in terms of a five-year time span,” Adams said. “But this doesn’t mean the patient has become cancer free within that time period. It could mean they’re now disease free, or it could be they’re progression free. What it means is that five years after they start treatment, they’re still alive.”
“My number.”
“Twenty-five percent,” Adams said. “If we don’t start treatment right away, that number could drop precipitously.”
Now it was my turn to swallow that medicine.
Twenty. Five. Stinking. Percent.
“Here’s where it gets a bit tricky,” Adams said, speaking in a voice that suggested “a bit” meant “a lot.”
I could see that Ruby was still trying to digest the 25 percent figure.
“How could it get more tricky?” she asked.
“The generic form of Verbilifide, the drug therapy you need, is currently out of stock.”
“When will it be back in stock?” I asked the question as if the drug were some part that could be ordered and picked up at Home Depot.
“I can’t tell you that.”
“What the heck! Why not?” Ruby asked.
“It’s just unknown,” Adams said, her voice tinged with frustration. “The manufacturer sent out an alert last month. They’re way behind on supply orders. To be honest, they’re not the only ones. Call any oncologist and they’ll tell you that we’re currently in the midst of the worst shortage of generic cancer medications that we’ve seen in decades. It’s a historic supply crisis with tremendous repercussions for both patients and their doctors.”
“What do we do?” Ruby asked. “My survival hinges on starting treatment right away!”
“Verbilifide isn’t in short supply, just the generic,” Dr. A
dams said, sounding reassuring. “We’ll have to prescribe you the brand name, that’s all.”
“So that’s not a problem, then,” I said.
“The generic costs a fraction of what Verbilifide will cost for a full course of treatment.”
I asked, “Meaning?”
“Meaning it will cost around three hundred thousand dollars.”
Ruby and I both looked sticker shocked. It’s bad enough confronting a cancer diagnosis, but to think about the financial implications conjures up the old “insult to injury” adage.
“I guess we can’t just go to CVS to pick up the drugs,” I said.
Ruby laughed, which almost made me cry.
“No,” Adams said. “I’ll need a week to order Verbilifide from a specialty pharmacy. They’d have the drug delivered to my office, and you’ll need to pick it up here. Just so I’m clear, you’re not worried about the cost?”
I shrugged off the number.
“Why worry about that?” I said. “That’s what health insurance is for.”
CHAPTER 3
From the bedroom, which doubled as a cramped home office, I opened a Safari browser on my MacBook Pro and typed the URL for my bank’s Web site. Afternoon sunlight spilled into the room from two windows, which the building’s superintendent kept promising to clean, while a steady breeze fluttered the curtains, casting movable shadows on the scuffed hardwood floor. Ginger, the orange tabby cat Ruby had adopted from the ASPCA last winter, perched herself on my lap and purred her pleasure. Her head darted all about, on a mouse hunt perhaps, as we’d had quite a few recent sightings. Not that we lived in a total dive, but this wasn’t the Ritz, either.
Seeing nothing of interest, Ginger opted instead to stick her head inside my water glass. Reflexively, I tilted the glass, allowing Ginger a drink, because that was what I’d done a thousand times before. Ginger had grown accustomed to drinking water out of a glass, and we hadn’t the time or inclination to break her of this curious habit. Meanwhile, my left hand deftly keyed in the username and password combination for my bank account. Ruby hovered close behind, scratching Ginger’s orange head while her kitty drank.
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