Saturday, 6:50 a.m.
The wristband said VOSS, TOBY. Under that it said DOB 01/01/1963, which somebody at registration had made up at ten last night because the field couldn’t be left blank, and under that, in smaller type, the word ESTIMATED.
Jo had been looking at it since four, when they’d moved him up from the ER. It was on his left wrist, the one with the short finger, and it was loose. She could have slipped two fingers in beside the bone.
Room 412 had one window, with the parking structure in it and past that a slice of gray river. The monitor over the bed drew his heart in green. Some hills, a flat, a crowd of hills. She’d counted them until five.
He was awake, the bed cranked up, the square of gauze on his temple, looking at the window.
“What time is it?” he said.
He hadn’t asked her that since Thursday. She checked the clock over the door.
“Ten to seven.”
He nodded at the window, as if the window had told him.
The young man’s oilcloth coat was on the sill, folded in a square. Dee had come into the ER bay at eleven last night and taken it off Pip one arm at a time without waking her, and handed it to Jo, and carried Pip out to the Highlander. She hadn’t said one word. That was how Jo knew how bad it was. Dee always said something.
Rob was asleep sitting up on a vinyl couch in the family lounge, his arms crossed and his chin on his chest.
“Your ribs,” she said.
“They’re okay.”
“Two of them are broken.”
“Dad did it.” He moved his hand on the blanket, a little, over the place. “They said he did good.”
◆
Feist came at 7:20 with a fellow and a laptop on a cart.
He was a small man in his sixties with a gray crew cut and running shoes and half-glasses pushed up on his head that he never brought down, and he shook Toby’s hand first, looking at the wristband while he did it. The fellow, a tall young woman with her hair in a clip, turned the laptop around so they could see it.
It was his heart. Jo knew it the way she’d have known a panoramic X-ray upside down across a room. A gray fan-shaped wedge, moving. Something in the middle of it opened and shut, opened and shut, and didn’t open far.
“This is your aortic valve,” Feist said, to Toby. He had a flat, patient voice, a voice for bad news in small rooms. “It’s the door between your heart and the rest of you. It should open about this much.” He made a circle with his thumb and forefinger. “Yours opens about this much.” He made it smaller. “It’s calcified. Your heart’s been pushing blood through it a long time, and the muscle’s gotten thick doing it. That’s aortic stenosis. Severe.”
“Stenosis,” Toby said. “What’s that mean?”
“Narrowing.”
“And the top of your heart has lost its rhythm. It’s quivering. Atrial fibrillation. A narrow door, and a heart that can’t keep time.” Feist glanced at Jo, and back. “You told the ER you’d been taking a plant.”
“Heart-leaf,” Toby said. “For the slow falling.”
“Foxglove,” Jo said.
Feist nodded as if he’d known. “Digitalis. The oldest heart medicine there is.” He tipped his head at the IV. “We’ve got you on digoxin, which is the same thing in a dose somebody measured. It’s why you’re alive. And it’s why you went down yesterday, two days off it. Whoever taught you knew what they were doing.”
“A healer gave it to me,” Toby said. “She said count the leaves.”
The fellow looked at Feist. Feist didn’t look at anybody.
“The nurses tell me you’ve got plans,” he said.
“I have to go home.”
“Where’s home?”
Toby held up his hand, flat, the palm down, about ten inches off the blanket.
“There’s a hole in a rock,” he said. “It’s about this high. It’s a long way in. It’s cold. I have to crawl through it on my stomach and it squeezes you, in the middle.” He put his hand on his chest, over the gown. “Here. It squeezes you here.”
“Mr. Voss,” he said. “I’ll be straight with you. Exertion, in a confined space, in the cold, with pressure on the chest. With this valve, this rhythm, two broken ribs and a heart that stopped yesterday.” He took his glasses off his head, finally, and folded them. “That would very likely kill you.”
“Okay,” Toby said.
Feist waited to see if there was more. There wasn’t.
“There’s a procedure.” He brought up a cartoon heart with a thin line snaking up into it from the bottom of the screen. “A TAVR. We go in through the artery at the top of your leg and bring a new valve up folded inside a wire, and open it inside the old one. No opening your chest. Most people go home the next day.” He tapped the screen. “Monday’s the holiday, but I’ve got a team coming in for one who can’t wait. I can make it two. I’d put you first.”
Jo was already doing it.
Monday morning, first case. Home the next day, most people. The door didn’t close until Tuesday late morning at the earliest, Toby had said so, on the bench, and she’d heard every word. Discharged at seven. Forty-five minutes to Calder, forty to the lake, an hour and a half up the trail at his pace, less with a valve that opened. There was time. There was time with a new valve in him and a heart that could keep a beat, and a crawl he might live through.
She looked up and he was watching her do it.
“No,” he said.
“Toby—”
“No surgery.” He said it to Feist, politely. “Thank you. I have to go tonight.”
“Tonight,” Feist said.
“Tonight.”
Feist put his glasses back on top of his head and stood.
“I’ll be on the floor till ten,” he said. “Page me.” At the door he looked back at the monitor. “Mr. Voss. Thirty-one years. I don’t say very likely unless I mean it.”
“I know,” Toby said. “You were nice about it.”
◆
When the door closed Jo got up out of the chair.
“Monday,” she said.
“No.”
“Monday. You heard him. You’d be walking by Tuesday. Tuesday morning I drive you up myself, with a valve that works, and you go through that thing with a heart that doesn’t stop halfway—”
“Mom.”
“It’s one day. It’s one more day.”
“It’s not a day.” He was looking at her now, not at the window. “Tuesday is the rest of Senna’s life.”
She stopped.
“And Aurel’s kid will be grown. He’ll have missed all of it.” He moved his hands on the blanket. “I’m not spending that on a new door for my heart.”
“You’ll die in that hole.”
“Then I die going home.”
He said it like pass the salt. That was the thing she couldn’t stand, how easy it came out of him.
“You don’t get to say that to me,” she said. “You don’t get to say that to me after eleven days.”
“It wasn’t eleven days for me.”
“It was for me.”
He didn’t answer that. He looked at her until she sat back down.
She sat with her hands between her knees. She knew about this. She had spent fifteen years in a chair beside people who didn’t want what was good for them. The man with the abscess who wouldn’t take the antibiotic because his brother-in-law had died on one. Mrs. Ruiz, who skipped her digoxin on weekends because it made her feel flat. You didn’t win arguing. You waited until they were tired and scared, and they always got tired, and they always got scared, and you were there.
“Where’s Dad?” he said.
“Asleep.”
“Will you get him? When he wakes up?”
She didn’t say she would. He didn’t ask again.
◆
Dee came at 9:40 with Pip.
The rain boots came first, squeaking in the hall, and then Pip in the doorway with her hair brushed and the butterfly clip put in right for once, over the part, which meant Dee had done it. Captain Otter was under her arm. She looked at the monitor and the IV pole and the man in the bed, and she didn’t come in.
Dee came in behind her in a Cascade Federal fleece, and Rob behind Dee, rumpled, with his work coat over his arm and his face gray under the beard.
“I’m taking Rob back to Calder for his truck,” Dee said. “Pip wanted to come.”
“Thank you.”
“I didn’t do it for you.” Dee didn’t lower her voice. She hadn’t lowered it for Pip since Pip could talk. “You lost her, Jo. For an hour, you lost her. She was on a bench across from your house with the whole town filming her and you were on a mountain with your phone off.” She set Pip’s backpack down by the door. “She stays with me this weekend.”
Jo looked at Pip in the doorway, at the clip over the part.
“This isn’t a question,” Dee said.
“I know it isn’t.”
Rob had gone to the window. He picked up the oilcloth coat off the sill and put it over his arm on top of his own.
“Kid’ll want it,” he said, to nobody.
Toby had turned his head on the pillow to look at Pip.
“Hi, Pip.”
“Hi.” She held on to the frame. “Did you fall down?”
“Yeah. I hit my head.” He touched the gauze. “Dad fixed me.”
Pip’s eyes went to Rob, and Rob’s went to the floor.
She came in then, slowly, along the wall, all the way around to the far side of the bed, as far from the machines as she could get, and stood at the rail by his hand. She inspected the wristband, and the IV where it went in.
“Does it hurt?”
“Not much.”
“Are you going to go home now?” She said it in her ordinary voice. “Toby’s friend said they’re waiting. He drew me.”
Toby turned his hand over on the blanket, palm up, beside the rail. Pip considered it. Then she put Captain Otter down on it, face first, carefully, and left her own hand on top.
“My kids are waiting for me, Pip,” Toby said. “Like you waited.”
“I waited a long time,” she said.
“I know. They did too.”
“At the door?”
“At a window. With a lamp in it.”
“That’s what he drew,” Pip said. She looked across the bed at Jo, and the look was the one she gave the spider in the bathtub. “Do I get to say bye? Before he goes? Last time I didn’t get to say bye.”
The room was quiet except for the monitor. Rob had his hand on the back of his neck. Dee was looking at Jo too.
“Yes,” Jo said. “You’ll get to say goodbye to him before he goes. I promise.”
Pip nodded, once, like a person closing a deal. She took Captain Otter back and went around the bed the long way, along the wall, and took Dee’s hand.
Rob stopped at the foot of the bed.
“What’d the heart guy say?”
“There’s a surgery Monday,” Jo said. “Through the leg. He’d be out Tuesday morning.”
“No surgery, Dad,” Toby said.
Rob stood there with the young man’s coat over his arm. He didn’t look at Jo. He looked at his son.
“I’ll be back,” he said.
“Bring Aurel.”
Rob didn’t say he would. He went out after Dee and Pip, and Jo heard the three of them go down the hall, the boots squeaking, until the elevator dinged and took them.
◆
At noon Toby pulled the leads off his chest.
He did it one at a time, peeling each little white sticker off his skin without hurrying and laying it on the blanket, and the monitor lost him one line at a time and began to complain. Then he started on the IV tape, working the corner up with his thumbnail.
“Toby.”
“Dad’s getting his truck. He can get me at the front. I’ll walk down to the car. You don’t have to drive me.”
He put his feet on the floor. His knees came out from under the gown, all bone, and he stood with one hand on the rail and the IV pole rolling after him on the line he hadn’t gotten out, and he walked to the door. Five steps. The monitor was shrieking at the empty bed.
At the door he stopped and put his hand flat on the frame.
The color went out of his mouth first, and then out of the rest of his face, down to the gray of wet concrete, and the sweat came up on his forehead all at once, the way it came up on a patient in the chair a second before they went. His lips opened for air and didn’t get enough of it. He didn’t let go of the frame. He was still facing the hall.
Jo had him under the arm before she knew she had crossed the room. He was shaking. He was heavier than he looked.
The nurse came in fast. Her name was Lorraine. She was fifty, with red cheaters on a chain and a voice from somewhere south, and she’d been kind to him all morning in a way that didn’t ask for anything back. She hit the monitor silent on the way past and took his other side.
“Whoa. Whoa, honey. What are we doing.”
They walked him back. He sat on the edge of the bed with his head down and his hands on his knees and breathed.
“I’m going home,” he said, when he could. “I’m sorry. You were nice. Against medical—” He looked at Jo. “What is it.”
Jo didn’t say anything.
“Against medical advice,” Lorraine said. “AMA. You can do that. It’s your right. But I’ve got to get the doctor, and you’ve got to sign a paper, and we’ve got to take that line out right, or you’ll bleed all over my floor.” She snapped two of the leads back on him, and the green line came back, too fast. “You didn’t make the hall, honey. You got somebody picking you up?”
“My dad.”
Lorraine glanced at Jo. Jo kept her eyes on the stickers on the blanket.
“Let me page Dr. Sato,” Lorraine said. “Sit tight.”
She went out. Jo went out after her and turned the other way.
◆
Dr. Sato was the weekend hospitalist, younger than Jo, on since six the night before. He was at the counter of the nurses’ station with a protein bar he’d forgotten he’d opened. He looked up when she said his name.
“Mrs. Voss.” He knew who she was. They all did. “Lorraine just paged me. He wants to leave?”
“He tried,” Jo said. “He walked to the door with the line still in him and went gray at the frame. I had to hold him up.”
Sato put the protein bar down.
“Is he related to you?”
“He says he’s my son.” She kept her hands at her sides. One of them wanted to go up, and she put it in the pocket of the hoodie, and kept it there. “My son is eight.”
Sato turned to the screen. He was typing, and reading. “Feist’s note says he described a plan to crawl into a cave.”
“The Whistler. It’s a mile up a trail from the lake. It’s forty-two degrees in there, and there’s a place at the back you go through on your stomach. He wants to go tonight. In the dark.” She heard how steady it was. “Dr. Feist told him this morning it would very likely kill him. He said, ‘Then I die going home.’ Those were his words. I’d chart them in quotes. He didn’t argue with Feist. He agreed with him. Then he turned down the one thing that would let him walk out of here on Tuesday, and three hours later he pulled his own leads.”
Sato stopped typing.
“Where I work,” Jo said, “a patient says that in the chair, you don’t let him walk out to the parking lot.”
“Has he said anything else? About wanting to die?”
“He says he’s going home.”
“Does he have family? Somewhere he could go, besides the—”
“Not here.”
It was quiet at the nurses’ station. Somewhere down the hall a call light was chiming, two notes, over and over.
“If he goes in there,” Jo said, “he’ll die.”
Sato didn’t answer. He had kind eyes and a shaving nick and he was weighing her, the mother of the missing boy, the one on the news, standing at his counter in her missing boy’s sweatshirt. She didn’t do anything with her face. She let him weigh it.
He picked up the phone on the counter. “I’m going to place a hold. He can’t leave AMA without capacity to make the decision, and from what you’re telling me, and Feist’s note, I don’t think he has it. Psychiatry has to see him. But it’s a holiday weekend. It might be tonight, it might be tomorrow.” He punched a number. “It might be Monday.”
Monday.
“We’ll get him a sitter,” Sato said. He held the phone against his shoulder. “You did the right thing, telling me.”
Jo took her hand out of her pocket. She didn’t know what she’d been holding on to in there. There was nothing in it.
◆
Lorraine told him.
Jo stood in the doorway. Lorraine sat on the edge of the bed, which she hadn’t done before, and read it off the form in her soft voice, and then took her cheaters off and said it plain. The doctor didn’t think he was safe to go right now. There was a hold. He’d have to stay till the psychiatrist saw him. It wasn’t a punishment. Somebody would sit with him, to keep him company. She was sorry, honey.
Toby listened to all of it. He didn’t interrupt her. When she was done he thanked her.
Then he turned his head on the pillow and looked at Jo in the doorway.
He didn’t look angry. She’d been ready for angry, for the look he gave her through the window of the Tahoe on Thursday. It wasn’t that. He looked at her as if he were working out how far it was, and whether he could walk it.
“You made me eight again,” he said.
Jo held on to the door frame.
“I let you,” Toby said. “That part is mine.”
He turned his face to the wall.
The sitter came at twenty past twelve, a girl with her badge clipped on upside down and a cup of cocoa from the machine, and sat in the chair in the corner. Lorraine put the rest of the leads back on him, one at a time, the little snaps, and he let her, and didn’t turn over. The green line on the monitor slowed, some.
A little before one he began to talk.
It wasn’t to Jo. It wasn’t to the girl in the corner. It was to the wall, low, a long run of it, rising and falling past the places where English would have stopped for breath, with his hand open on the blanket behind him. She stood in the doorway and listened for a word she knew. Once she thought she heard one, and it went by her before she could be sure, and he didn’t stop.
The girl in the corner looked up from her phone.
“Is that Spanish?” she said.
“No,” Jo said.
At one-thirty she was still standing in the doorway. He hadn’t turned around, and she hadn’t gone in.