Fallout Read online

  A Volvo approached from the other direction. There was only one Volvo in town. It belonged to the newspaper editor, Josh Gibbs.

  Holt waved. The editor continued on by, his eyes never leaving the center of the road. I might as well be invisible, Holt thought.

  Josh’s head was filled with fears and possibilities. He imagined the worst. Katie was pregnant. No, that couldn’t be, she hadn’t even had her first period. Or had she?

  He imagined the more probable. Katie had made a face and called him a worrywart but maybe he’d been right about a stress fracture. He hoped the doctor wasn’t going to tell him she couldn’t attend soccer camp but he was prepared for that. Despite an innately optimistic spirit, Josh had learned from experience that news from doctors was seldom good.

  A hole opened in his chest. He loved his daughter so much and still there was so much about her he didn’t know. It was only going to get more difficult as she grew into an adult. She needed a mother—something he could never be. Already, he felt he had failed her.

  He parked on Main Street and walked the half-block to the coffee shop. It took a moment for his eyes to adjust and then he spotted Allison. She sat away from the other patrons, long legs crossed beneath a wrought iron table, making her black skirt appear very short. Shoulder-length light blonde hair framed her face. Josh searched her expression for some hint of whether the news was better or worse than what he had imagined.

  Chapter Six

  Allison silently cursed medical schools for failing to teach how to deliver bad news.

  Medicine could describe the function of almost every organ in the human body and instruct doctors what to do about problems. But courses on how to interact with fellow human beings instead of biological systems weren’t part of the curriculum. State medical boards didn’t test communications skills. It was something she had had to learn on her own.

  Many physicians lacked the basic understanding that such communication was important. Allison noticed a correlation with certain specialties. Brain surgeons often saw individuals simply as the product of a series of electrical impulses. Anesthesiologists seemed to prefer dealing with patients who were unconscious. Radiologists generally were more comfortable with pictures, not people. Ob-Gyns and general practitioners tended to be the best at patient communication, although it wasn’t always just about the specialty. She remembered one GP who’d fainted when faced with having to inform a patient he was HIV-positive. And communication wasn’t her father’s strong point, either at the clinic or at home.

  Trial and error had taught Allison to have difficult conversations away from her medical office. Everything about it, from the big desk, to the mysterious medical equipment, to her white lab coat, fostered the impression that the doctor was a god delivering a pronouncement of doom to a weak and helpless mortal. Coffee shops, on the other hand, were places where everyone was equal and where friends gathered to share information and solve problems. She’d found nothing in the privacy portions of the Health Insurance Portability and Accountability Act that proscribed private medical discussions in such places—as long as they weren’t overheard.

  Ruling out the Koffee Kafe, which she was sure barely squeaked by its yearly health inspection, and the Cluck N’ Cup, which closed at 3 p.m., she had picked the Java Joynt for her conversation with Josh, confident that so late on a Friday she wouldn’t run into her ex, Vince Bludhorn. The overbearing, hardball-playing in-house lawyer and general fixer for the Recovery Metals recycling plant was such a regular patron that the establishment had named coffee with a double-shot of espresso “the Counselor” after him.

  She had also observed that whatever attitude she personally adopted during bad news conversations tended to be the attitude that the recipient adopted. If she was scared, the patient was likely to be scared. If she was calm, the patient often would be calm. Today, her emotions were bouncing all over the place. She was worried about what Josh and Katie might be facing. She felt guilty, as if she had let Sharon down. She was sick at the unfairness of it all.

  Arriving early, she had chosen an herbal tea to steady her nerves and claimed a quiet table toward the back. As Josh bypassed the barista and bee-lined for her table, she tried for an expression that conveyed: concerned, but not worried.

  Unsuccessfully, judging by his face.

  Josh scraped a chair across the tile floor and sat. “What’s the headline?”

  “I’d like to get some more tests run on Katie. There’s a feature on her x-ray that may relate to the pain in her leg. It may be nothing but it could possibly be serious.”

  He stiffened. Anything termed “possibly serious” in Sharon’s case had invariably turned out to be so. He took a deep breath. “How serious?” he asked calmly, thinking that if he limited his panic he could somehow limit the threat.

  Allison knew Josh wouldn’t stand for anything but the truth, straight and unvarnished. Even as Sharon faded he had badgered her caregivers to tell him the unknowable: How many weeks? How many days? She took a breath. She couldn’t believe Josh had to hear the word again. “Worst case, I’m somewhat worried about the possibility of cancer.”

  Josh deflated into his chair. His eyes closed. His head weaved unsteadily.

  “There’s no need for panic. This is a concern, not a diagnosis. It could be nothing. I want someone else to take a look. Coretha’s setting you up for Monday at the hospital in Columbus. There’s a great children’s wing.”

  Josh looked stunned.

  “Cancer’s not a death sentence.” She regretted the words as soon as they left her mouth. It certainly had been a death sentence for Sharon.

  “What kind?” Josh asked numbly.

  “A bone cancer, if it is cancer. Osteogenic sarcoma.”

  “What stage?”

  “If it is cancer, we caught it early.” Josh looked dead. She placed her hand on top of his. “I know how you must feel,” she sympathized. “This can’t be happening again.” Neither moved for a minute. She could see him start to regain his bearings. He withdrew a reporter’s notebook from his pocket and uncapped a pen.

  “What makes you think Katie has cancer?” He asked it like he would a question at a press conference, responding as a journalist, creating emotional separation from bad news.

  “Might have cancer. She attributed her leg pain to jumping out of a tree. I x-rayed for a stress fracture. There was none. I was looking at the x-rays again this afternoon and I noticed an anomaly I hadn’t seen before. It could be a bone bruise. It could be congenital. It could be a bad x-ray. It could be something else. I’m not a pediatrician, I’m not an orthopod and I’m not a radiologist. That’s why I want someone else to take a look. I do this sort of referral frequently. Often, it’s nothing.”

  Josh folded up the notebook. He lived by the mantra of his first great city editor, Walker Burns, who taught him to assume nothing. If your mother says she loves you, check it out, is how Walker had phrased it. “I want to see the x-rays,” Josh said.

  “You won’t be able to tell anything.”

  “Maybe not. But I need to see.”

  Coretha joined them in the examining room at the clinic. Allison slid the three views of Katie’s left leg into the tray and doused the overhead light.

  “As you can see, the tibia and fibula show no sign of fracture, even a stress fracture. But look up here, at the bottom of the femur. Right above the knee cap.” Allison touched a spot on the x-ray with a pen. “That’s what I’d like an expert to look at.”

  Josh squinted at the x-ray. “Look at what?”

  Allison moved to a second x-ray. “It might be easier to spot here.” She circled an area above the knee. “This could be a mass about twenty-five centimeters diameter. See the irregular cloudy area, a denser white than the bone that seems to intrude into the surrounding tissue.”

  “No. I think you’re seeing things.”

  “Possi
bly,” Allison conceded.

  “We had a problem with some x-rays,” Coretha volunteered.

  “What do you mean, ‘problems with the x-rays’?” Josh said sharply.

  Allison shot Coretha a look of disapproval. “Some films of a patient’s jaw came out strangely this week. We don’t know why it happened.”

  “Your machine is broken,” Josh said calmly. “There’s nothing wrong with Katie.”

  Josh was clearly in denial but Allison desperately wanted for him to be right. “I hope so,” she said. “But we had several sets of x-rays taken at about the same time that didn’t have any problem, including Katie’s, as far as we can tell.” She looked to Coretha for confirmation but found she had slipped out of the room.

  “So some x-rays are screwed up and some aren’t. I’m betting this whole thing is a mistake. What are the odds?” Josh demanded. He was feeling slightly better.

  Allison flicked on the lights. “We don’t know. That’s why you’re going to take her to Columbus.”

  Josh pressed close to the x-rays. “So what am I supposed to tell Katie?”

  Allison took him by the shoulders and turned him so she could look him in the eye. “Tell her the truth. Tell her the doctor wants to find out what’s causing the pain in her leg and that more tests are needed. That’s all we know.”

  Allison summoned Coretha when Josh had gone. “Josh is having to live with this all weekend. Creating uncertainty in his mind about the quality of the x-rays didn’t help.”

  Coretha looked downcast. “Sorry. I didn’t even think about that.”

  “Well, if there is an x-ray problem, we need to find out.”

  “I’ll call the company and get them to send out a tech. With any luck, they can be here Monday.”

  Chapter Seven

  Josh parked in the driveway of his neat, two-story brick house, its window boxes now lacking flowers for a third summer. He realized he had no recollection of the drive from the coffee shop. He felt weak, outside himself, physically ill, as if a cold stone were lodged in his gut.

  Once again, he was trapped in the cruel limbo between knowing and not knowing but having to imagine the worst. The next seventy-two hours would be a torture awaiting test results and consultations with specialists.

  He slammed the steering wheel in frustration. What was he going to tell Katie? What could he tell her? He needed to say something but he wasn’t going to make her worry. Cancer certainly would not be mentioned, especially since there was a good chance that this whole mess was the result of a problem with an x-ray machine, not with Katie’s leg.

  He took a deep breath and went inside. Katie was on the computer.

  “Hi, Dad,” she said without looking up from a women’s soccer website. Josh gave his daughter a kiss on the top of the head and began the routine of making dinner. It wasn’t easy. Every thought he had evaporated before he could finish thinking it. He had to read the instructions on the blue and yellow box of pasta three times before he managed to put four quarts of water on to boil.

  Josh broke the news while Katie was clearing the table and he was at the sink doing dishes. “We need to go to Columbus Monday.”

  Katie shoveled a final bite of macaroni into her mouth and handed him the plate. “What for?”

  “Dr. Wright wants a doctor there to take a look at your leg. She’s not really a leg expert and we want to make sure you’re in good shape for soccer camp.”

  “Do I have to miss school? It’s almost the last day and Monday’s a field trip to the plant.”

  Josh turned off the water and dried his hands. “Yeah. Sorry.”

  “Well, I already went to the plant with the Girl Scouts. Can I go to Emily’s tonight?”

  “Are her parents home?”

  “Yes.”

  “What are you going to do?”

  “Watch a video.”

  “Promise?”

  “Daddy!”

  “Be home by ten-thirty.”

  “It’s Friday night!”

  “Okay. Eleven.”

  He struggled with his fear for the rest of the weekend. He went to the office Saturday intending to review the payables and receivables but ended up scouring the Internet for information on osteogenic sarcoma. Later, having convinced himself that there was a good chance he was worrying for nothing, he buried himself in making a list of what Katie would need for camp.

  Only once did he slip. He looked in on her Saturday night before he went to bed. She was so engrossed in the computer she didn’t notice. He stayed to listen to the gentle sound of her breathing, marveling at how much she was growing to look like Sharon and disbelieving that something so perfect and pure could harbor something so offensive and deadly. The same thought he had had about Sharon’s breast.

  After a while, she became aware of his presence. “Hi, Dad. Are you okay?” she asked.

  A lump formed in his throat. So like Katie to worry about others. For a moment he was speechless. “I was just . . . I wanted to say good night.”

  Chapter Eight

  With no breakfast to eat Monday morning, it was only a few minutes until they were headed to the bridge to Ohio thirty miles away.

  A mist rose from the bottomland as they snaked north. Josh snapped on the Volvo’s yellow fog lights but was forced to slow. He read the clock on the dashboard and calculated. He had driven the route so damn many times with Sharon that he knew to the minute how long each segment should take, with variances calculated for every weather condition, every day of the week, every time of day. His math suggested that as long as the fog cleared by the time they crossed the river, they’d be okay. No, he thought. Not okay. On time.

  So many times. All so futile. He looked at Katie sleeping in the seat beside him, covered in her mother’s throw. Maybe this time it would be different.

  The Volvo neared an old steel bridge that reminded him of something built from an Erector set. On the West Virginia side was the familiar faded sign that still pointed the way to Betheltown, a long-abandoned community condemned to make way for the recycling plant. The quick-rising sun burned off the fog as they crossed the bridge into Ohio.

  The western Appalachian foothills flattened quickly into rolling fields of young corn, endlessly repeating. Signs touting newly sprouted gas stations, fast-food restaurants and a cluster of chain hotels hovered just over the tree line. A parade of high-tension towers marched across the hilltops in the rearview mirror.

  Josh set the cruise control for sixty-four miles an hour. Ohio cops didn’t mess with you if you were going less than sixty-five. He pinched his cheeks to stay awake. He yearned to turn on the radio but didn’t, not wanting to wake Katie. His eyes burned. His chin sank toward his chest on several occasions, but when he pulled the Volvo into the parking deck at the hospital, adrenalin kicked in.

  Katie clutched his hand as they rode the elevator to the hospital’s entrance. “Daddy, I’m not going to miss camp, am I?”

  Josh didn’t answer.

  A security guard nodded as if he recognized Josh. Josh nodded back. Sad, he thought, when the hospital is where they know you best.

  The building’s automatic doors opened and the bite of ammonia assaulted him, halting him in his tracks. Over the months of Sharon’s so-called treatments, the smell had been an ever-present reminder of the sickness growing inside her. It was the smell of hopelessness, of murdered dreams and despair. Today, it brought him to his senses like a blow to the face. Anger rose in him like a burning, caustic tide. He felt a fierce protectiveness toward Katie, a primal sense of possession. She was his daughter—his last tangible link to the woman he had shared his life with for more than fifteen years. All his hopes, wishes, everything he held dear were embodied in this thirteen-year-old girl. It was his duty, his sacred honor, to keep her from harm.

  Like you did for Sharon. It came to him unbidden and he ch
ased it back to the darkness where irrationality reigned and fear was a constant companion. After Sharon, he had hoped never to see this place again. But here he was and as much as he wanted to believe that everything would be okay, months of conditioning had left their mark. The old wounds were opening, oozing dread.

  At least he was about to get some facts. He had been living in a world devoid of them. That had enabled him to avoid thinking about diagnoses, treatment options, even whether Katie could still go to camp. Having no facts had made optimism easier.

  But having no facts was a professional contradiction. As a journalist, he lived for facts. He felt uncomfortable without them. With enough information, he believed, most problems could be solved. Given facts, one could at least take considered action, exert some measure of control. Despite their potential for horror, facts were where it all had to start.

  Hours later, he still didn’t have any. The bureaucracy of insurance forms had taken forever, long enough for Katie to finish The Red Pony and many publications on the end tables in the main lobby. Then, infuriatingly, all the receptionists, office manager and other hospital personnel meandered off for a coffee break when he had a sick daughter and wanted answers. Josh fumed as one receptionist and the office manager stopped on an outside patio to smoke before they returned to work.

  Katie left in search of more to read. Josh strolled to the unmanned reception desk in hopes of spotting a schedule, a sign-in sheet, anything that might give him a hint about when they might be seen. Nothing. Lured by a table with a stack of slick magazines, he wandered into an empty waiting area in administration. Disappointed when all the magazines turned out to be trade publications devoted to arcane aspects of hospital management, he killed time by practicing a skill at which he had once been legendarily proficient—reading things that were upside down. In his heyday, they had been memos and letters and papers on the desks of the New South business leaders and politicians and their secretaries across from him—documents that sometimes led to exciting scoops that no one could understand how he’d gotten. Today it was purely an exercise, a chance to see if he still “had it,” the memos, apparently awaiting approval, as meaningless to him as the articles in Hospital Manager Today—one about how a cutback in Medicaid reimbursements meant the Hospital Authority would have to start charging employees for parking; a six-month-old directive about switching to UPS for isotope deliveries to the departments of Radiation Oncology and Nuclear Medicine; a new memo about blood sterilizer inventory; and a badly-in-need-of-editing letter from the hospital’s legal department to the admitting desks about rights and responsibilities in dealing with undocumented, Spanish-speaking patients with no insurance. Josh could have summarized it in two sentences: Don’t ask for proof of citizenship. Do get cash or a credit card up front.