“How much is in the checking account?” Ruby asked.
I clicked. Then I clicked again.
“Two thousand,” I said. “Give or take a thousand.”
Ruby grimaced. “What? Why are we so low?”
“Um, let’s see. We’re down to one income, which after business expenses, food, taxes, car payment, my school loan, your tuition, and utilities . . . leaves us with just about zero every month.”
“Oh, goodness.”
Ruby didn’t ask me about our savings account. She knew I had drained it long ago to climb the Kang. “Live the life you want to live today,” is what Ruby always preached. It’s one of the reasons I loved her so much. She didn’t just support my passions—she actually got me.
Today I just wanted Ruby to live. It’s funny how life gets really centered, and really quickly, too, when you’re forced to confront what’s truly important. Each day, each moment Ruby and I had together, her health, her comfort, that’s what I cared about now. That’s all I cared about. I reached over my shoulder and grabbed hold of her delicate wrist. Ginger, surprised by the sudden movement, leapt from my lap and onto the floor with a soft meow.
“Don’t worry,” I said. “It’s going to be fine.”
“Do you know how much our insurance is going to cover?”
“No. But I have a call in to Atrium. They should be calling back soon. We’ll figure it all out, I promise.”
Ruby sighed and flopped down on the bed—technically, just a mattress and box spring on the floor. Bed frames were for grownups, she once said. I admired her from my desk chair, taking in every detail like a slow, calming breath. Ruby, beautiful and lithe, fit her surroundings the way a tiger blends into the jungle. I had ceded all apartment-decorating decisions to my wife. The furniture came from various consignment shops. The color scheme, turquoise and white, evoked a feeling of living in a beach cottage, because that was where she longed to be—an ocean community, replete with artsy people who valued acupuncture and holistic healing. Clutter, she kept to a minimum. Everything about our home was peaceful, like Ruby before her disease.
“You know what’s weird?” Ruby said as she gazed absently up at the cracks in the ceiling, her arms bent at the elbows, hands interlocked and resting behind her head. “I don’t feel sick, just tired.”
“Hopefully, after that drug, we won’t have to know what cancer feels like.”
Ruby sat up and got cross-legged on the bed. “That drug sounded worse than the cancer.”
“That drug is the most important thing in our lives.”
“Liver problems. Irregular heartbeat. Skin rashes. Upset stomach. Fuck this, John. I mean it. Fuck having fucking cancer. I can’t stand it.”
I got up from my chair and plunked myself down on the bed beside Ruby. I put a hand on her knee but knew not to hug her. Ruby could be like Ginger that way. At times she wanted to be petted and scratched; other times she was too prickly to be touched. But I kept my hand resting on her knee, knowing she’d eventually cave in to wanting comfort. When she fell against my chest, I wrapped her in my arms and wouldn’t let go.
“Are you ready to tell your mother?” I asked, brushing Ruby’s hair from her face and eyes.
Ruby pulled away and sighed. “Sure,” she said, “but I’m not expecting anything.”
“She might surprise you,” I said.
“How? By getting sober and buying a plane ticket?”
“Something like that.”
Ruby shrugged off her mother the way I had the cost of her medication.
“I won’t hold my breath.”
The phone call from Atrium came an hour later. Ruby was fast asleep in the bedroom, cocooned within a burrow of blankets. Ginger was nestled up next to her and making that super-loud “I’m the happiest cat in the world” purr.
The agent from Atrium, a whiny-sounding man, introduced himself as Leonard Tate. “How are you doing this afternoon?” he asked.
I thought he sounded young—maybe just a few ticks past his frat party years. I told him what was going on with Ruby and how her doctor was going to prescribe her a course of treatment for Verbilifide.
“I’m sorry to hear that,” Tate said, not sounding all that sorry to me.
“I wanted to make sure that everything checks out okay for my wife’s treatment as far as our insurance coverage goes before we start,” I said.
“Of course,” Tate said.
The line went uncomfortably silent. I could hear fingers tapping away at a keyboard. He seemed to make an impossible number of keyboard clicks for the information he’d set out to retrieve. Clickety-clack. Clickety-clack.
Following an interminable amount of time, Tate asked for my health insurance account numbers, which I already had given to the annoying phone tree disguised as Julie, a saccharine-sounding computerized agent who couldn’t have been less helpful if she spoke only Yiddish. I didn’t bother asking Tate why Julie couldn’t pass along my account numbers to a living, breathing person. It’s been my experience that most large companies have antiquated technologies. And Atrium, both large and anonymous, trumped all other insurance companies with the lowest customer satisfaction ranking according to Ranker.com, which compiled such lists from actual customers. The Internet was a powerful equalizer that way. If you failed to meet customer expectations, you’d be sure to hear about it. Atrium knew to offset their prickly corporate culture and rankled consumer base with the lowest rates going. The bottom line was, we couldn’t afford better insurance coverage.
Tate keyed in the numbers as I read them. More silence. More fingers tapping away, but this time I could hear Tate make a couple deep sighs—disconcerting, to say the least—immediately followed by yet more finger tapping. I imagined Tate was seated inside a cubicle somewhere. Maybe he had a plant on his desk. A picture of his girlfriend, perhaps. Did this stranger understand the importance of our conversation? Did he realize lives were at stake? Could he relate to me as more than just a health insurance account number on the other end of his headset?
The answer, according to Ranker.com, left little doubt.
“So, Mr. Bodine, I’ve pulled up your health-care policy, and I’m afraid there’s a problem with the coverage.”
I felt the floor drop out from underneath me. “What do you mean, a problem? My payments are automatically deducted from my bank account,” I said.
“This isn’t an issue with the status of your coverage. That’s not in question.”
“Then what is?”
A creeping sense of dread started at my toes and began to inch its way up through my body.
“Your plan will not cover the cost of Verbilifide, because there’s a generic alternative available,” Tate said.
My loud and relieved sigh made Ginger look, though Ruby, still buried beneath her many blankets, didn’t budge.
“For a second there I thought we were going to have a real problem,” I said. “The generic drug for Verbilifide isn’t available,” I explained. “You can check that with Ruby’s doctor if you need confirmation.”
“Yes, well . . .” Tate hesitated in a way I didn’t like one bit.
“Yes, well, what?” I said.
“The actual availability of the medication isn’t the issue as far as our policy is concerned. Technically, there is a generic alternative.”
My pulse started jackhammering away, and I knew my voice would waver if I tried to speak. I felt my face flush as I attempted to swallow down a simmering rage.
“It’s not available,” I said, speaking the words loudly, as if maybe that would aid his comprehension. “It’s out of stock.”
“Yes, well, when it gets in, it will be covered—minus your deductible, of course.”
“Minus my . . . when it gets in stock . . . What . . . what are you trying to say?”
Thank goodness for cordless phones. Not wanting to wake Ruby, I left the bedroom, anticipating the volcanic eruption to come.
“I’m sorry, but this is the policy. We
don’t cover brand-name drugs if there is a generic alternative.”
“It’s not available, Mr. Tate!” I shouted into the phone, squeezing the handset so hard that my fingers ached. “How can my wife take something she can’t get? Tell me, how is that possible?”
“I understand that you’re upset,” Tate said.
“Upset? Upset? No, upset doesn’t even begin to cover it. Are you telling me that my wife and I are on the hook for a three-hundred-thousand-dollar course of treatment?”
“Unless you take the generic,” Tate said.
“I can’t get the generic! I can’t get it! What part of ‘it is not available’ don’t you understand? How is this not getting through to you?”
A steely bolt of anger revved inside me, threatening to explode in a vitriolic tirade unless I paced the room.
“You elected to have the most inexpensive policy,” Tate said.
“There are a number of constraints to your drug coverage.”
“I elected to have the most inexpensive coverage because that’s all I could afford. The monthly premiums are already ridiculously high. For what? What in the hell am I paying you for?”
I heard footsteps behind me and whirled at the sound. Ruby ambled out of the bedroom, wrapped in a snuggly blanket. Her hair stuck out at odd angles, and she seemed unsteady on her feet. I cupped the receiver with my hand.
“What’s going on?” she croaked out.
“Nothing, babe,” I said. “Just talking with our insurance company. Minor hiccup. I’ll get it all worked out.”
“Well, keep your voice down,” Ruby said, feigning an irritated tone. “You’ve got to let a sick girl get her rest.”
“I’m sorry,” I said.
“So sorry that I was such a fool,” Ruby sang, soft and sweetly.
She held up a finger. Another point. I recognized the melody from a classic country tune but didn’t recall the artist. I smiled weakly, giving Ruby’s forehead a mollifying kiss. Meanwhile, I’m thinking, We’re screwed.
CHAPTER 4
Standing at the base of the Wilhelm Genetics skyscraper, I tingled at the thought of riding up in the glass elevator. I was sure the view of the Boston skyline from the fortieth floor would be spectacular, but there were lots of spectacular views I could no longer stomach. I had only five minutes before my appointment with Vivian Sutcliffe, director of patient access for Wilhelm Genetics, to get my nerves on.
Train delays. Damn trains.
I did everything possible to get here early enough to take the stairs. Man plans. God laughs. Still, arranging this meeting was no simple task, and I wasn’t about to let a little thing like paralyzing acrophobia keep me from making the appointment on time.
My conversation with Leonard Tate, now two days in the past, deteriorated faster than a reality star’s career. Tate must have said, “I’m sorry, but that’s our policy,” at least a dozen times before I demanded to speak to a senior customer service representative from Atrium. Then, like tag team wrestlers, it was Carlotta Duncan’s turn to say, “I’m sorry, but that’s Atrium’s policy.”
I hung up the phone, leaving the Atrium reps with the highly ineffective parting salvo, “Thanks for nothing.” I couldn’t think of anything more clever to say. I was too floored, too angry, too dumbfounded to speak.
Rather than stay stuck in Atrium’s maddening constraints, I turned my attention to the Web, where I found a glimmer of hope in the form of Wilhelm Genetics Access Solutions program—a service for patients and their health-care providers to assist with coverage and reimbursement support. Hopefully, this trip on the insurance merry-go-round would yield me the brass ring.
Wilhelm Genetics newly constructed headquarters in Boston’s downtown financial district stood in stark contrast to the surrounding historic buildings that gave the city its unique architectural character. The towering skyscraper was a rectangular structure, ultramodern in design, which reflected Boston’s scenic harbor in its mirrored glass windows. I entered the foyer, shaking off a seasonally cool early April day in New England. If there was one bit of hope to be extracted from the building’s sleek interior, it was a feeling that this company could afford to be charitable. The burnished marble floors and walls appeared flecked with gold, while the majestic light fixtures descending from a thirty-foot-high ceiling would fit in just fine at the Museum of Fine Arts.
My footsteps echoed across the cavernous space on my way to the security desk, manned by two sentries well dressed in white oxford shirts, black ties, and official-looking badges. I signed the guest registry, noted the time on my iPhone—two minutes until my meeting with Sutcliffe—and then followed their directions to the elevator bank. Already I was shaking, and I hadn’t yet set foot inside what my brain considered a glass tomb.
My mind kept saying, Don’t be late, but my body spoke otherwise.
I wish I had listened to my body.
Acrophobia comes from the Greek ákron, meaning “peak, summit, edge,” and phobos, meaning “fear.” Fear of heights is not an irrational emotion, especially if there is no protection to safeguard one from a fall. But I’m a mountain climber, dammit. I once lived my life on the edge. Now, years after what I did to Brooks Hall, I can’t even get near an edge without getting the shakes. My shrink wasn’t too surprised by the sudden onset of the condition. Acrophobia has historically been attributed to a traumatic experience involving heights. Newer theories have evolved, casting some doubt on that supposition, but I’d be willing to bet none of those theorists ever cut a safety rope, knowing he’d kill the guy bound to the other end.
The elevator chimed, doors whooshed open, and four other people, close to my back and waiting for a ride up, basically pushed me inside. Buttons were pressed. Floor numbers illuminated. I was going to the highest floor. Figured. The doors closed with a Star Trek–like swoosh, and the elevator blasted skyward like a rocket ship. From behind me, I heard an ooooh and aaah from one of the passengers gazing in wonderment at the rapidly diminishing view of downtown Boston. Meanwhile, my throat closed and every pore in my body began to secrete something: salt, water, and fear.
I felt my face flush, heartbeat fluttering like a bird newly freed from its cage. I held my breath but could feel my knees start to go slack. The roomy elevator seemed to get smaller, as if the four people riding up with me were multiplying, engulfing every conceivable square inch of space.
Don’t pass out. . . . Don’t pass out. . . .
I closed my eyes tight, balled my fists. Then I saw him.
Brooks wasn’t wearing his sunglasses, though. His eyes were nothing but two dark voids, wide and round like a doll’s, while his face had gone entirely black from frostbite. My hands involuntarily jerked upward, as though I’d been holding on to a taut rope that had been sliced in two. My mouth formed an O shape, allowing my silent scream to escape. I kept my eyes closed tight and felt fuel injected with panic.
I used to stand on the top of the world.
Just when the air inside the elevator seemed as thin as it did at twenty thousand feet, the voyage came to an abrupt stop. I opened my eyes and saw we were only on the twentieth floor. I jumped out of the elevator, pushing aside a woman who had planned to get off on that floor. She wasn’t bothered by my abruptness, it seemed. I suspected she’d seen my skin go pale as snow, eyes ringed with sweat, wide and alert. My chest kept heaving, as if I were breathing through half a straw.
“Are you all right?” the woman asked. She looked ready to call 911.
“I’m fine . . . fine . . . ,” I managed to wheeze out. “Think I’m going to take the stairs from here. Quick twenty-floor hike will do the heart some good.”
Her smile expressed great relief in not being called upon to perform CPR and equal degrees of gratitude to be free of my company.
I found the stairs and climbed the twenty floors at a brisk pace. I made it to the top, carrying with me a stark reminder that my condition hadn’t lessened with the years. If anything, it had only gotten worse.
/> I arrived at Sutcliffe’s office breathless, my face flushed, T-shirt soaked with sweat, and heart still hammering. I took a seat in the waiting room after giving my name to the receptionist. The demure woman seated behind a glass enclosure offered me a drink of water, along with a weary assessment of my condition. I drank in slow sips while waiting ten long minutes for Sutcliffe to show. I guess only one of us cared about being punctual.
Vivian Sutcliffe, a stocky woman dressed in a plaid skirt and black turtleneck sweater, with dark hair to match, emerged through a double set of glass doors. She gave me a congenial smile that somehow conveyed sympathy. It was certainly a practiced reaction on her part, assuming most visitors came to her under the cloud of troubled circumstance.
“Mr. Bodine,” Sutcliffe said, extending her hand. “I’m so sorry I’m late. Busy morning. I hope you had an easy time getting up here. Security can be pretty arduous these days.”
“It wasn’t a problem,” I said.
“Did you love the view coming up? I never tire of it.”
“I’m sure it was beautiful,” I said.
Sutcliffe paused, showed some confusion in her large brown eyes, but didn’t press for an explanation. I kept pace as she led me down a carpeted corridor with low ceilings, illuminated by the artificial unpleasantness of fluorescent lights. She opened the door to a conference room, motioning me to join her inside. The room itself was small, one round table and four chairs. Thankfully, no windows.
A glossy blue folder awaited me on the conference table. It was chock-full of papers and titled Wilhelm Genetics Access Solutions. A photograph of a well-dressed man, maybe in his early sixties, adorned the front cover. His silver hair, neatly trimmed, accentuated deep creases on his face, giving him the distinctive look of power. I thought it peculiar that Wilhelm Genetics’ marketing material didn’t advertise a beaming, happy family, saved by the generosity of the Access Solutions program.
It all became clear when I read the accompanying copy. The man whose face adorned the front flap of the Access Solutions folder was Manfred von Wilhelm, CEO of Wilhelm Genetics. His message to prospective consumers was simple: “Because everyone should get the medicine they need.”
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