Symptoms of a Heartbreak

by Sona Charaipotra

  I’m starting another search, when I hear a loud rap, rap, rap, on the desk, right near my arm.

  I look up, startled, and Davis whacks the table between me and Howard with her pen. Like an old-school teacher with a ruler. Rude.

  “You may have noted the multiple signs requesting that cell phones be put away while in the oncology ward, no?” Crankypants says, looking over her glasses at me. “They cause cancer.”

  “So does everything else, right? It’s what keeps us in business.” Ouch. I regret it instantly, without even having to see the horrified look on Davis’s and Howard’s faces.

  She points, and I follow her gaze. Howard works hard not to crack a smile. Yup, there are signs, for sure, tacky white ones with bright blue writing and a frilly border, one of those old clunker cells pictured below the bellowing text. They’re posted everywhere—on the wall behind the nurses’ station, on the opposite wall heading toward the patient rooms, wherever you look. In fact, I’ve memorized them. That doesn’t seem like the wisest thing to say.

  “I thought they were for patients and parents,” I say.

  “Get off your phone this instant. You’re here to work, Ms. Sehgal. Need I repeatedly remind you of that?”

  “Dr. Sehgal,” I spit back. “Need I repeatedly remind you of that?” As the words leave my mouth, I kind of want to duck and hide. If she could give me demerits or detention, she would, I’m sure. Or she could fire me. Like, right now. And I’m fed up. So I flash the EMR app on my phone. “I am working.”

  Davis peers at it for a second, then turns on her heel and storms off with a harrumph. I’m sure she’ll make note of the incident in my file. She’s gathering them all rabidly, the way Lizzie and I used to collect unicorn stickers, waiting for the day she can show off her collection and kick my ass out of here.

  “You know that’s a losing battle,” Howard says. “She doesn’t have to call you doctor when not in front of patients.”

  “Yes, but it sure is fun to poke her.” Howard and I dissolve into giggles, and she peers at me over her glasses, like Davis did.

  “What are you all laughing about?” Nurse José asks, walking up with files in hand. “Was Cho snoring again?”

  “No, Dr. Davis. I do like pissing her off.” I flash my teeth at him in glee.

  “Keep it up, and we’ll both end up on her hit list,” Howard says. “Where’s Cho?”

  “He’s been asked to consult on a new case. I’m sure you’ll hear all about it as soon as he sees you.”

  “No doubt. Should we get started?” I say, and he starts to hand me the files. “Nope, let’s do them one at a time.”

  We run through the list, checking in on the usual suspects.

  I prep myself as we head into Alina’s room. Her big blue eyes and bright demeanor remind me so much of Harper—and so do her symptoms. I take a sip of water and a deep breath. My stomach flips as I walk into the room. Clearly psychosomatic, but it still hurts. Literally.

  “It’s that Sasha, I tell you. Always talking, saying ‘so pretty, so sweet.’ She cursed that child with the evil eye.” The voice is coming from a small, weathered woman, a crown of white tufts on her head, her face wizened like a golden raisin. “I tell you, Vanya knows that healer in Brooklyn, we should bring her in. What can it harm?”

  “You must be Bubbe,” I say, standing in the doorway, and the lady grins, perfectly straight teeth. Dentures, like Dadi’s.

  “Ah, the girl doctor.” The woman reaches up and touches my shoulder. I’m taller than her at five foot two. “Alfred told me of you. But you are very young.” I laugh, and she grins again, but when I offer my hand, she backs away. “Well, child, come in. Don’t stand in the threshold.” I follow her into the room, and she leads me to Mr. Plotkin, rather than Alina. Because in Russia, like in India, children should be seen and not heard. Not listened to.

  And the news we bring isn’t good. Her white blood count is low. She’s struggling.

  Deep worry lines indent Mr. Plotkin’s face, and I know he can tell, too. He stands near the bed, dabbing her forehead with a cool compress and giving himself an ulcer.

  I take one look at Alina and start worrying about congestive heart failure—a side effect that’s killed plenty of patients. She’s a twig, collarbones jutting from her hospital gown, bruises marking her cheeks and arms, her eyes sunken and bulging, her cheeks swollen from the fluid retention. The blue bruises are spreading across her pale white skin like a raging river flooding its banks. It’s only been a few days since we last met, but already the change is drastic.

  “I’m okay,” she says as her grandmother frowns. “I had ice cream for lunch. Plain old strawberry, better than nothing,” she says, then waves me over. “I would die—pun intended—for some good pad thai. Do you think you could make that happen?”

  I laugh. “I’ll see what I can do.”

  Cho glares my way, then proceeds with updating vitals. “You’re handling chemotherapy well, and we’re thinking about trying an even stronger dosage to be more aggressive with our treatment.”

  “I don’t want to be more aggressive,” she interrupts. “I don’t want to do this at all.”

  Bubbe grimaces, but she’s nodding. “She doesn’t need a doctor. She needs a healer.”

  “I need a break,” Alina says, and I can feel her wanting to roll her eyes at her grandmother. “I need it to be over. Either way.”

  “That would be ill-advised.” Cho doesn’t quite look at her, instead focusing on making notes in his folder.

  So I have to chime in. “You’ve got to get better if we’re gonna stuff you full of Thai food and ice cream,” I say. “And I’m waiting for the day when you’ll cook for me.” I lean down close and whisper, “In fact, remind me to show you my sister’s FoodTube videos. I bet you could do some, too.”

  She cowers into the bed and winces—in pain and something else—and I realize how insensitive my comment was. The cancer is literally eating her alive. The last thing she wants right now is witnesses.

  “I can’t cook. I can barely eat,” she says, bursting into tears. “I can barely get up to go to the bathroom, and every time I brush my hair, it falls out in clumps.” She runs her hands to show us, strands of it spilling into her palms. “My friends are back from their vacations and having pool parties and I’m stuck here, all by myself.”

  I swallow hard. “I’m sure they can visit,” I say. My voice sounds defeated, even to me. In the end, it was just me and Harper all the time. Because Lizzie bailed early. And then even Vish stopped showing up.

  “Yeah. I don’t want them to come here and see me like this,” Alina says. “I can’t blame them for not wanting to be here. Can you?”

  Yes. Yes, I can. And, I realize with Lizzie, I still do.

  But I don’t have time to worry about that right now.

  “Well, you need to focus on getting better,” Howard says.

  “As I said—and I’ll discuss this with your father—a more aggressive treatment is probably the smartest option,” Cho adds.

  When she looks at me for my take, I bite my lip and nod. He’s right. Even though it kills me to admit it.

  Mr. Plotkin sighs. “Can I talk to you guys for a second outside?” he asks. Bubbe starts hovering and fussing as soon as we head to the door, waving us away, dismissive.

  We follow Mr. Plotkin out, the worry in his voice unsettling all of us. As soon as we’re a few feet from the door, he breaks down, a shudder moving through his thin frame. “My wife lost her job last week,” he says. “Which means we have one month of insurance on Cobra, and then we’re—”

  “Shit,” Cho says, then catches himself. “I mean, that’s very unfortunate. Does your work provide any kind of coverage? Maybe we could talk to someone—”

  “I’m a professor,” he says. “I mean, adjunct. There’s nothing. She was the stable one. But all the time away, here with Alina, made them think she wasn’t taking the work seriously. How could she? This is life or death. Don’t they u
nderstand?”

  I step forward, putting a hand on Mr. Plotkin’s shoulder. “We’ll call the insurance and see if they can extend the Cobra out. Legally, they have to provide a year and a half.”

  “We just can’t afford it.” Mr. Plotkin looks grim. “We won’t be the first to lose someone because of this. Or the last.”

  “We’ll do everything we can to prevent that,” I insist. “We’ll fix this, Mr. Plotkin. Do you trust us?”

  He nods as he clasps my hands, but his are shaking.

  * * *

  Our next stop is little Brendan Jackson, and his grandmother.

  “I asked them to discharge him this week,” Ms. Ruby says, her voice full of conviction. “This is all too much for him, really. I think the best thing is to just to keep him home, to pray on it. But Ericka insisted we keep him here. She won’t quit until there’s nothing left of the boy,” she adds, her voice dropping, even though Brendan’s got his earbuds in, his eyes focused on the game he’s playing on his phone.

  “Frankly, Ms. Ruby, I tend to agree with your daughter,” Cho says too harshly. “I do believe his condition is deteriorating, and treatment is critical.”

  “I’d like to see evidence that this is medically necessary,” Ms. Ruby says, her chin jutting. “Show me the proof that he’s improving. I think all these chemicals are just making him worse.”

  That’s when I notice the tears slipping down Brendan’s face. He’s still staring at the screen, silent, seemingly unaware. The salty streaks marring his still-round cheeks betray him.

  “You see, Saira, dear,” Ms. Ruby says. “My boy’s tired. Exhausted. He can’t take much more of this.”

  If he doesn’t, he’ll die, I want to say. But I don’t.

  “These things take time, Ms. Ruby,” Howard says. “It’s always darkest before dawn.”

  Ms. Ruby nods, but I know what she’s thinking: Her grandbaby’s life is at stake here, and time is the one thing they really don’t have.

  We go back to the intern lounge between patient check-ins, and while Dr. Howard inputs chart updates, José plops himself down in cushy papasan chair I’ve stuffed into the far corner.

  “This was a good decision,” he says, removing his loafers and curling up into it. “Can we take twenty before the next go? I’m going to close my eyes a minute.”

  How can he sleep when the world’s falling apart? I log on to my laptop. I use the intern landline to call the Plotkins’ insurance company and ask about an ETA for the transfer paperwork, on speaker, so the whole team can hear.

  “The Cobra extension is pending approval,” the woman tells me in a nasally voice. “They have another insurance option available.”

  “No, they don’t.”

  “Yes, through the father’s university job,” the woman says.

  “I don’t think that’s a feasible option,” I say.

  “Hold, please.”

  While the Muzak plays, I watch the video of Link again—on silent, of course—on my phone. I’ve been watching it nonstop for days, like a total stalker. I haven’t seen him since the mall.

  “Dr. Sehgal?” The nasal lady’s back on the line.

  “Yes, ma’am,” I say. “All set?”

  “No, actually, we’re not,” the woman says. “Cobra is pending approval provided they prove the university insurance is not an option. In the meantime, the other issue is on your end. The hospital administrator says they won’t readmit the patient until prior invoices are paid. Dr. Davis, the head administrator, declined approval.”

  “What?”

  “Dr. Davis—”

  “No, I mean, I heard you. I don’t understand.”

  “It seems, Dr. Sehgal,” the woman says, all snark, “that you have been overruled. So I suggest you take it up with her.”

  “Oh, believe me, I will.” I slam down the phone without saying goodbye. It gives me no real satisfaction. Alina needs this treatment. Needs. Or she will die. I have to do something about this.

  José perks one of his perfectly groomed eyebrows at me. He stands, towering over me, and tries to place a calming hand on my shoulder. “Breathe, Saira. Now, I know, I know. You’re mad. Don’t go storming in there like this. It’ll only make things worse. Let’s figure out what to do.” He ponders for a second. “Maybe a GoFundMe?”

  “We can’t do that,” Howard says, shaking her head in disbelief. “I mean, maybe I can walk Mr. Plotkin through the process, but legally we have to stay out of it, per hospital rules.”

  I’m shaking, I’m so mad. I have to get myself together. José’s right. I have to stop, breathe, think. “I know what to do. I’m going over Davis’s head—I’ll speak to Dr. Charles, the hospital chief, about this directly.”

  Howard’s about to lecture, but Cho steps into our little circle then, his face grim. “Come on,” he says, completely ignoring my rant, as if nothing’s wrong, as if this is business as usual. Which I guess it is. “We’ve got patients.”

  I nod, and José gives me one more encouraging pat on the shoulder. Then he passes us each the new patient file.

  I take one look at the name on top and nearly pass out, dropping the file. Paper is everywhere, and José drops down to gather it up as I blubber incoherent apologies. My cheeks are blazing and my neck is slick with sweat.

  It’s him.

  Link.

  Lincoln Chung-Radcliffe.

  He’s been right here all along.

  And then I realize what that means. A readmit. That can’t be good news.

  “Shit,” I say. “I’m sorry. Shit.”

  “You gotta watch the mouth,” José says. “Davis is definitely not gonna be pleased if she catches that.”

  “Uh-huh,” I say as he and Howard head out. “Hey,” I call, hanging back. “I’m too wound up. Maybe I’ll go see Dr. Charles.” Or Davis. “Can you guys can do this one without me?”

  Nurse José walks back to me, takes his little flashlight and checks both of my eyes. Then he takes my stethoscope and tries to place it over my heart, although my white coat’s in the way.

  “What are you doing?”

  “You must be sick,” José says, incredulous. “Do you want Davis to fire you? Because missing rounds is a smart way to do it.”

  “Yeah,” Howard says. “Besides, Cho’s already winning—and you know we can’t have that.” She heads out the door, fully expecting me to follow.

  I sigh. This was inevitable, of course. The odds that he’d be admitted to my very small department and not have me on his case were minuscule at best. And aside from dropping dead this very second, there’s nothing much I can do to change things now.

  Patient Name: Lincoln Chung-Radcliffe

  DOB: February 11, 2001

  DIAGNOSIS: Acute myelogenous leukemia, metastatic

  PROGNOSIS: 30 percent success rate with chemotherapy; 50 percent if a donor match is found

  NOTES: Lincoln Chung-Radcliffe was admitted to Princeton Presbyterian for acute leukemia, metastatic, his first recurrence. He was previously treated at Princeton Presbyterian with a similar diagnosis at age 13 via CAT scan, blood count, and bone marrow biopsy. Treatment via chemotherapy eradicated the growth, sending the patient into remission, though follow-up care was continued.

  Relapse occurred when the patient was 16, after two years cancer-free. Dr. Arora, who supervised the patient’s care during his initial occurrence, admitted as inpatient for an aggressive plan including chemotherapy, to stop myelogenous growth from progressing in his bone marrow. However, Dr. Charles observes that perhaps the best course of action is immediate mandate for bone marrow transplant, as this is a recurrence.

  CHAPTER 14

  My heart drops as I read through Link’s chart. I knew it was bad, but I didn’t know how bad. He’s been putting on a brave front. Which is good, in a way, staying upbeat. But also terrible.

  I’m not ready—for any of this, really, at all—but I know the time has come. I have to face him. And I have to tell him the truth.
r />   But I’m a mess, in all ways. I stop in front of the mirror by the sink on the way out and take a second to smooth my hair—and my eyebrows, which are at it again. I rush out the door and catch up with the others.

  I head toward Lincoln’s hospital room, my body heavy with dread. The dress under my lab coat is drenched with sweat, and even my feet in my flats feel sticky and gross. The worst part is the way my heart is racing, a too-fast thrum I haven’t experienced since I took the MCAT—severe heart palpitations, generally a signal of intense anxiety or stress. Usually harmless. Except when you’re about to face the boy you kind of, sort of like and clearly shouldn’t like, who thinks you’re a kid, like him, and not the Girl Genius who’s officially about to be one of his cancer doctors. Who needs to tell him that his diagnosis is pretty grim.

  I take a deep breath outside the door, then push it open. Howard, Cho, and Arora are already surrounding the bed—and Nurse José is giving his usual chipper introduction. A woman—she looks a lot like him, of Korean descent with dark hair and tired brown eyes—so I assume she’s his mom—stands lean and tall at the edge of the bed next to Howard.

  I tuck myself sort of behind Howard, slightly out of sight, and hope to get through this unnoticed.

  “You’re in great hands here at Princeton Presbyterian,” Nurse José says. “Drs. Cho, Howard, and Sehgal here will be working with Dr. Arora—who’s familiar with your case from the last time—to plot out a course of action.”

  “Dr. Cho, will you outline your proposed treatment strategy for Lincoln’s case?” Dr. Arora says, looking at his own patient file. He looks exhausted, too, but flashes me a bright smile.