Do No Harm Read online

  Josh smiled shyly at Katie, the nurse who was getting him settled. She chucked him under the chin. “I’m going to call you Captain Smiley,” she declared. Josh giggled.

  After she left, I turned a cartoon on for Josh and sat on the couch next to Nate, leaning my head on his shoulder, while Moira settled on a chair next to us. Josh was asleep within a few minutes.

  “Oh, Moira!” The door flew open and a woman with short curls dyed brownish red, sagging jowls, and a colorful patterned dress plowed across the room and pulled Moira against her massive bosom. “Thank you for texting me. We’re all just so devastated!”

  Moira’s eyes filled with tears. “Thank you, Bertie.”

  Bertie handed a handkerchief to Moira, who delicately dabbed at the corners of her eyes.

  “This is Bertie.” Moira introduced us. “From my church.”

  Anger spiked through me. How dare she. This was personal, and we’d only just found out. It wasn’t her place to be spreading it around.

  “Pastor John and I are here to help.” Bertie dabbed at moist eyes. “We’ve set up a GoFundMe account and we’re organizing a bake sale this weekend to help pay for this treatment. We’re all praying for little Josh.”

  Thoughts and prayers, I thought bitterly. Like that does any good.

  “Thank you,” Nate managed.

  He always remembered his manners. But I couldn’t bring myself to answer. I wanted to be grateful, I did. But what was selling a few cookies going to do to save Josh’s life? Her thoughts and prayers weren’t action. They didn’t change a thing.

  An awkward silence rang out in the room.

  “Thank you so much for coming by, Bertie, it was really lovely of you.” Moira guided the woman toward the door and almost pushed her out.

  “What the fuck, Ma?” Nate snapped when she returned.

  Moira flinched. She hated cursing. I gaped at Nate, surprised he’d sworn in front of her. He was a bit of a wimp when it came to his mother. In fact, I couldn’t think of any time I’d heard him be so overtly critical.

  I slipped my hand into his. Two against one.

  “You’re already telling people?” Nate scowled.

  “Just church people.”

  “That’s still people!”

  Moira turned to me. “She means well,” she said. “She did the same thing when Matt had his stroke. And when we moved Matt into the nursing home, she set up a schedule so someone visited most days of the week. Okay, it didn’t change anything, but the support helped. I couldn’t have done it without her.”

  I nodded, a little surprised that she was appealing to me, not Nate. When Nate and I first started dating, his whole family had welcomed me with open arms. I’d never felt more a part of a family than I had with Nate’s. Except when it came to Moira. She’d been stiff and cool, strangely judgmental since the day I met her. I knew she thought I wasn’t good enough for Nate.

  Moira closed her eyes. When she spoke, her voice wobbled. “Emma, how hard will the treatment be on him?”

  Nate’s and Moira’s gazes were heavy on mine. They both wanted—no, needed—my words to be positive ones. It was my job to reassure people, to help them understand and accept. Disappointing people hurt, but I knew it was even worse to hide the truth.

  I thought about what my dad used to say: You don’t get to choose what cards you’re dealt any more than you get to choose who your patients are. You just gotta make those cards work for you.

  I blew out a breath. “His best chance of survival is the CAR T-cell therapy, and the question isn’t how hard it’s going to be, it’s how much it’s going to cost.” I looked at Nate. “We have to find a way to get the money for that treatment.”

  * * *

  NATE WAS watching me with that intense, questioning look he sometimes got. He wouldn’t bring it up in front of his mother, but he wanted to question me about how I knew Dr. Palmer.

  Instead, I asked him to call our neighbor and see if she could let Charlie out and feed him, then brushed my lips against his and left to grab my purse and phone from the clinic.

  The hospital’s third floor, where the clinic was located, was quiet, the lights dimmed. The overhead fluorescents flickered briefly, a soft hum emanating from the bulbs.

  I expected to use my key card, but the door to the clinic was still unlocked when I arrived. I slipped into the empty reception area and moved past battered plastic chairs, an empty water dispenser, and end tables with magazines splayed across their tops.

  I hurried through the door leading to the exam rooms, but stopped abruptly when I noticed a light. Marjorie was still working in her little office at the end of the hall. I could just see her profile through the door, which was open a crack, her long graying hair hanging over her face as she stared down at a pile of folders. Her desk radio played the Eagles softly.

  I didn’t feel like talking to anybody, so I moved quietly across the laminate floor on my tiptoes, escaping into the medical office. I closed the door with a gentle click and slowly pulled open the desk drawer where I’d left my purse, careful not to let the metal drawer runners creak.

  Before today, losing my parents was the single worst thing that had ever happened to me. After they died, my brother, Ben, and I went into foster care. Neither of our parents had any family who could take us, so we were left with just each other.

  Foster care wasn’t as bad as you’d think. Our foster parents were nice, and we were lucky we got to stay together. But they had two of their own kids, and it was clear we weren’t part of their real family.

  Once, shortly after my parents died, they had a birthday party for their oldest daughter, Kelly, a spoiled girl with brown eyes and bad skin. They had a cake, streamers, balloons, a unicorn piñata.

  One of Kelly’s uncles had them all pose for a picture. Still aching from my parents’ deaths, I’d jumped into the photo, grinning like an idiot and wrapping an arm around Kelly’s shoulders. My foster mother had firmly moved me out of the way.

  “We’d like a picture with just our family,” she said, smiling politely. Just our family.

  That was when I realized I didn’t belong. I was an outsider peering in the window.

  The next few years, Ben and I coped in very different ways. Ben acted out. Sometimes he stayed out all night, sometimes for days at a time, picking up girls and drugs and bruises along the way. By the time he was seventeen, nobody tried stopping him anymore.

  I coped by being careful and good and smart. I wore my responsibility like an invisibility cloak in school. But as much as I tried to be the person my parents would’ve been proud of, to blend in and be good and not be a bother, Ben stood out in the most horrible way possible to a good girl.

  He was a bad boy.

  He got kicked out of school for dealing when he was a senior and I was a sophomore. He left one day without even saying good-bye. I found out later he’d gone to juvie. He’d been making drugs in a shed in the woods by our foster family’s house, and they’d turned him in.

  And just like that, I was all alone. Not only had I lost my mom and dad, my brother was gone too.

  I learned my lesson then. You can’t take anything for granted. You can’t stand by and leave things to chance. The people you love can die, and you’ll be alone. You must always be alert, ready to fight.

  It was almost twelve years before I felt like I belonged again. Twelve long, lonely years before I met Nate and we had Josh and became our own family.

  My thumb grazed the screen on my phone, lighting up the picture on my screen saver. Josh was in my arms, looking directly at the camera, while I had my forehead pressed to his cheek. Nate’s arms were around both of us, his chin on my head. We looked happy.

  I grabbed a sheet of paper from the printer and drew a line down the middle, making two columns: incoming and outgoing. I opened the banking app on my phone and scrawled our monthly salaries in the incoming column, then did a quick tally of our bills, my medical school loan payments, and my malpractice insurance
in the outgoing.

  I stared at the digits as fear corkscrewed through me.

  I couldn’t lose my son. We had to find the money.

  I shoved my phone and the paper into my purse and slipped undetected down the hall. The radio was still murmuring, Marjorie singing tunelessly along.

  In the hall heading toward reception, I noticed the supply closet was open a crack. I moved to shut it, remembering that Julia had said people kept forgetting to lock it. But something made me stop.

  I pulled the door open and peered into the murky closet. There were drug samples arranged at the back. To my right, a stock of rubber gloves, tongue depressors, thermometer heads, bandages, antiseptic, blood pressure cuffs. And just beneath them, stacked on the shelf in neat piles, was the stock of prescription pads for all the clinic’s doctors.

  CHAPTER 8

  “JOSH HAS ACUTE MYELOID LEUKEMIA,” Dr. Palmer told Nate and me the next day.

  We were sitting in his office surrounded by gleaming rows of medical degrees, shining glass awards, and framed certificates. A handful of photos of his daughter over the years sat on the window ledge behind him.

  “We’ve caught it early, but I won’t lie, this is tough to cure. We need an aggressive treatment plan, and we need to start now. Without treatment, survival of AML is usually measured in weeks, not months. I can’t promise Josh would even see the new year.”

  My hand flew to my mouth, and Nate gasped loudly, his face draining of color.

  “We have two options,” Dr. Palmer continued. “We can do a high dose of chemotherapy, followed by a targeted therapy drug and a stem cell transplant. Or we can go the CAR T-cell immunotherapy route. As I said, the hospital’s insurance only covers a portion of the treatment, but it is FDA-approved so they should at least cover some of it.”

  “I’ll call and find out more today,” I told Nate.

  “You might get stuck with hospital stays, blood work, extra tests,” Dr. Palmer warned. “It will cost a lot, no matter which way you look at it.”

  “We’ll do whatever it takes,” I said.

  Dr. Palmer steepled his hands on top of his desk, his gaze heavy on mine. “Josh is, what, just a few years younger than you were when your parents passed?”

  Nate’s head swiveled to face me. There had been no time last night to tell him how I knew Dr. Palmer. “Eight. He’s eight years younger than I was.”

  “Let’s be sure we’re fighting to save the same person.”

  I swallowed hard. “Josh is all that matters. He has a chance to live if we get him the CAR T-cell therapy.”

  * * *

  NATE CAUGHT up with me in the corridor as I strode quickly away from Dr. Palmer’s office.

  “You want to tell me what that was about back there?”

  “What?” I didn’t want to do this now.

  “With Dr. Palmer. How do you know him?”

  I kept walking. “It doesn’t matter.”

  Nate grabbed my arm, forcing me to stop. “Don’t do that, Em. Don’t shut me out.”

  “What do you want me to say?”

  “I want you to make me understand!”

  I wished with all of my heart I could share more of myself with Nate. But the wounds from my past were too raw and deep. Talking about it, exposing them to anyone, even someone who loved me as deeply as I knew Nate did, was like rubbing them with salt. I’d taught myself long ago to lock it away, and that decision had allowed me to live.

  I sighed and continued walking, slower this time. It would be easier to talk if he wasn’t looking at me.

  “I don’t like thinking about it, let alone talking about it,” I said finally.

  “I want to be here for you, to support you, but I can’t if you won’t talk to me.”

  We stopped outside Josh’s room. Nate brushed a finger across my cheek, his eyes creased with concern, but he didn’t speak. He was doing that cop thing he did where he waited for me to fill the silence. He was much better at this game than I, and he knew it.

  “My parents were picking me up from a friend’s house. My dad had been drinking. He had a stressful job and he maybe didn’t cope with it very well. My mom was mad at him for driving when he’d been drinking, but he wouldn’t listen. When my dad got something in his head, there was no changing it. Anyway, he got a call, and Dad said we had to go get Ben. He was driving too fast on this tiny rural road. I don’t remember much about the crash, to be honest. Just afterward. My mom…”

  I gulped, hating the memory, wanting to push it away. “She died on impact. I got my dad out.… I had no way to get help, so I just sat there with his head on my lap. He died like that. We waited for what felt like hours, and nobody…” My voice trailed off and I took a shaky breath. “Dr. Palmer saw the smoke from the car. He called the police and took care of me. He saved my life.”

  Nate tipped my chin up so I was looking at him. His eyes were filled with such tenderness it brought tears to my eyes.

  “I watched my dad die, Nate,” I whispered.

  “Josh is going to be okay.” Nate’s voice was firm. “We’ll get him this treatment.”

  “We can’t even afford to buy a new couch.”

  “We’ll find a way.”

  I pulled the paper I’d tallied our bills on from my purse and thrust it at him. “How are we going to afford five hundred thousand dollars for this treatment? We barely have enough money to pay rent each month.”

  Most doctors didn’t start earning a full-time salary until ten years after they graduated, and most primary care physicians earned barely more than what they had in medical school debt. Money had never mattered to me before. I only ever wanted my own family and to help people. But now, money was all I could think about.

  Nate barely glanced at the paper.

  “I’ll get a loan,” he said. “I have a buddy at the bank who’ll help. We’ll get on a payment plan with our insurance, and I’m sure my mom will help.”

  “She can’t help! The rent we pay her covers your dad’s care. Otherwise she wouldn’t even be able to afford that.”

  “We have our pensions.”

  “It isn’t enough!”

  Nate scrubbed a hand over his jaw. “Lieutenant Dyson told me he’s retiring next year. He basically said the job’s mine if I can crack that murder case from a couple days ago.”

  I gaped at him. “You can’t be serious. Josh is sick! He needs us. Both of us. If you take that case, we won’t ever see you.”

  “If I get that promotion, I’ll get more pay and better hours. We’ll be able to pay off whatever we have to borrow.”

  “Sitting at a desk all day doing paperwork? Come on, Nate, you’d hate that!”

  “It doesn’t matter. It’s not about me, it’s about Josh.”

  Tears stung my eyes. I bit my lip, hard, the coppery taste of blood prickling in my mouth. But it was better than useless, pointless tears.

  It was an impossible situation. We did need the money, but Josh needed his father too. I needed my husband.

  I touched his hand. “We need money now, Nate. Not next year.”

  A flash of panic glinted in Nate’s eyes. “I can do this,” he insisted stubbornly. “I can provide for my family.”

  “Stop with the misogynistic bullshit,” I snapped, losing patience. Nate was so used to being responsible for everybody, providing for his mom, his brothers and sister, the people of our community. I’d found it endearing when we first met. But he couldn’t provide for Josh by getting a promotion next year. “It isn’t up to just you. We’re in this together.”

  Nate shook his head, and the air between us tightened. I stared at my husband, a dark swirl of horror winding through me. I’d always thought the best couples should complement each other, like peanut butter and jelly, cookies and milk. Nate was all sunshine and hope, while I was the realistic pragmatist. But together we made a balanced whole.

  Now, though, he was engaging in blind denial when I needed certainty. I could see that Nate wasn’t going t
o offer me that.

  We’d reached an impasse.

  * * *

  DARK, ANGRY-LOOKING clouds were moving in from the west, pushing toward the mountains and hovering over town. I could smell the rain in the air. A gust of wind swept up a handful of leaves and slapped them against my ankles.

  It was lunchtime, a crowd of doctors, anesthesiologists, and nurses gathered outside the staff entrance smoking and chatting as I hurried past. People thought that medical professionals didn’t have vices. That we were these omnipotent, perfect people with Madonna-like serenity. That we didn’t take antidepressants and never needed something as taboo as a line of coke to stay up studying for the board exams while moonlighting to make enough money to pay our bills at the same time. But I could say from experience, doctors were humans. We had vices like everybody else.

  I pulled a crumpled pack of Marlboro Golds from the bottom of my bag and lit up as I climbed into my eleven-year-old Honda. I rolled my window down and pulled out of the parking lot, inhaling slowly. My lungs felt like they were being wrapped in a warm, downy blanket. Ash sprinkled on my open window. I flicked it away. Nate would kill me if he found out I’d been smoking.

  I drove slowly down Main Street. The Christmas lights were already strung up and would be turned on tomorrow. Usually we went to the tree-lighting ceremony in town, a thermos of hot chocolate clutched in Josh’s hands.

  I headed out of town toward Seattle, making two calls as I drove: one to my office, leaving a message for Marjorie to call me, and the other to our insurance company, starting the claim process for Josh’s CAR T-cell therapy.

  Once I was far enough away from Skamania, I stopped at a cash machine and withdrew some money. I bought a couple of cheap, prepaid cell phones from Target, as well as a bag of Nate’s favorite snickerdoodle cookies, and hopped back in the car. My phone chimed a text from Nate.