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“Do you understand,” Doc Glenn said to Alice, “you are in the thrall of a neutropenic fever?”

Tearing eyes looked at the doctor like he was insane. “Of course I don’t understand,” Alice answered.

“For all practical purposes,” the doctor said, “your body can’t protect itself from anything right now.”

She urged Oliver to ignore the old man, “drive us straight back to the city—our people are there, they can help with whatever needs helping.” In response the doctor let Oliver know that, in his professional opinion, Alice would not make it back to Manhattan alive. “We have to have an ambulance anyway,” Oliver thought out loud. “Can’t the same paramedic just stand over and care for Alice all the way back to the city?” Oliver volunteered to foot the bill for the mileage costs, then nodded through the doctor’s administrative blarney—the drive being a nonemergency, elective use of an ambulance probably not covered by insurance as an in-network cost. Like he knew or cared what any of it meant.

Oliver pressed further. Calls were made. But even if one of the Manhattan hospitals covered by Alice’s insurance plan had an available bed—which they didn’t, but even if they had—none of those wards would accept a body with almost no white blood cells after six straight hours on the road.

Frustrating as this clusterfuck was, Oliver—like many of his programming peers and former grad school classmates—had spent huge swaths of his adult life devoted to logical progressions, the evolutionary dances of trial and error that went into problem solving. So, yes, he felt the urge to lash out, punch something solid. But he also understood that every reason something couldn’t work provided more information, another small jigsaw piece, the borders and edges gradually filling, a cumulative suggestion developing.

This is happening,
he told himself.
Whether it feels surreal, or melodramatic, or whatever, this is happening.

Now two men in dark uniforms angled the stretcher, making sure Alice’s legs were raised higher than her head so that the blood would flow toward her brain. “Precautionary measure,” explained the bulkier paramedic, whose responsibilities seemed to include talking to Alice. “Keeps patients from going into pulmonary shock.”

That’s really a possibility?
Oliver started to ask. The question stalled in his throat. Its answer was apparent in the black stabilizing straps being buckled tight across his wife’s chest, the secondary set constricting her thighs, the exam room now crowded and jostling and serious. The paramedics were counting to one another, one two tres; Alice was looking up, searching, her face pale, waxy. Her eyes were red and brimmed with tears. Now she locked in on him.

—

He would never forget those contractions, Alice taken by pain so encompassing as to be frightening, this highly functioning adult—this woman he loved so much (he felt his love throbbing inside each of his heart’s four chambers)—reverting back to her mammalian origins, making horrible, primal sounds, the totality of her being committed, shrieking. Oliver was freaked, admittedly, and self-conscious to the extreme, but he absorbed the shooting pain from his wife’s grip, and squeezed her hand in return; he breathed in tandem with her, and the contractions continued, and, on count, she pushed with all she had (
pushpushpush, breathe, pushpushpush
), and his gaze remained trained on her spread legs, making for damned sure that he was watching every second. Why had nobody told him he needed to watch and stay trained, why had he needed to figure this out for himself? Only after each contraction receded, when the baby was that much closer but not yet crowned, when they had a minute or whatever to recover and get ready for the next push, only then had Oliver looked back up at his wife’s face; still continuing to count, still breathing in tandem, he’d used his free hand to pat her sweaty brow, repeating just how beautiful she was, how great she was doing.

This time her grip wasn’t crushing the long bones of his fingers. Rather, she was clasping his fingertips. When this became too difficult, she was hanging on to the edge of his coat, holding its seam between her thumb and pinkie. Oliver still had the warm bundle of their daughter on his chest. He leaned down. Alice had just begun losing the pregnancy weight from her cheeks and chin. “I can’t believe how much I want to fuck you right now,” he whispered.

She coughed out the laugh he wanted. But by then the paramedics were lifting her, she had to let go of his sleeve. For an instant her arm remained hanging, outstretched. She looked back at him, her eyes huge.

Shielding his daughter from the sight of Mommy being wheeled out of the room, Oliver shouted, “Don’t worry about anything.” He rocked the baby to his chest, promised, “We’re right behind you. We’re with you.”

His wife was receding, down the hall, toward an ambulance, away from him. “We’re in your heart,” Oliver shouted. “We’ll beat you there, I bet,” his screams almost gleeful. “We love you so much. I LOVE YOU SO MUCH
.
”

—

Flakes of snow, random and swirling, drifted through the darkness of the small twin windows. She followed a single flake: it flipped along a gust of wind, ricocheting off the glass. Alice couldn’t guess how long she’d been in here, how long they’d been driving. She couldn’t hear the sirens, but from the way any pothole jostled her, the ambulance had to be going pretty fast. If she concentrated enough she could block out the beeping updates of her vital signs, the itching down the middle of her torso from this thin cheap blanket. What couldn’t be ignored was the weight. Settling atop her chest. She imagined it so clearly. Light but firm. The black box with that black ribbon, tied in a huge, sagging black bow.

“I know this is overwhelming,” Doc Glenn had said. Deep rivulets were etched in the skin around his eyes. “But whatever you are about to go through, you’ll be able to get through it a lot better if you can learn to live with not knowing the answers. It’s the patients who can handle uncertainty. They’re the ones who deal with these situations better.”

The ambulance came out of a turn and slowed, its vibrations lowering an octave. Arriving felt important: one part ending, a new one beginning. This was the transition. These moments were moving her into the part where she found out what was happening inside her body. The engine cut; the ambulance went still; for long seconds Alice looked up through the two long square windows, into the gloom, alone with the darkness and the black box and the anticipation. Then the doors opened; night flowed into the chasm, the chilled air stinging her cheeks. A few orange bulbs scattered light across the loading dock. As the paramedics set Alice down onto the cement landing, cascading flakes landed on their knit hats and thick winter parkas and gloves and thermal masks. She noticed the far wall of the parking area was cushioned: rubber bumpers for when the ambulance couldn’t afford to slow down.

Alice’s stretcher rotated, turning at an angle; she was rolled over rough asphalt. Beyond the boxy silhouette of hospital buildings, she could see the layering of dark mountains, a smear of charcoal sky. Inside swaths of the dock’s streetlamp and tower light, the snowfall seemed like fireflies and stardust and the refractions off untold tiny spinning diamonds. It seemed to her the scene could have been manufactured on a Hollywood soundstage, or was part of an odd dream. She raised her head from the stretcher; snow stung her cheeks. For long moments she almost believed some peculiar form of magic was indeed waiting for her. Alice could not help herself: she extended her tongue.

—

If she hadn’t pulled it together at the rest stop, found a second wind, and recovered enough to convince Oliver to get them to her mom’s, so they could all have one nice goddamn holiday weekend, please. If her mom hadn’t looked at her daughter in the bedroom that morning and ignored Alice’s protests and placed that call. If good old Doc Glenn had been hosting his children and grandkids for Thanksgiving like he did during even years, and had been occupied with all that, instead of just waiting to board a flight, his mind not quite engaged by that newsweekly magazine. If the pay phone hadn’t been free, and the doctor hadn’t checked his service, heard that panicked call from a longtime patient, and followed up. If what might have been some dinky country office hadn’t actually been fairly up-to-date, with modern equipment including a gizmo that could take lung X-rays. If the very same doctor whom Alice had considered a cornball bozo when she was growing up, with such little mental firepower, had indeed been a cornball, and had been satisfied with the X-ray’s discovery of pneumonia, and hadn’t ordered a round of blood tests, just to be sure. If that same little office hadn’t had access to a blood lab that
not only
turned around results on the same day but also remained open for business on all days, including legal holidays. If pretty much everyone in the area code with anything resembling a normal life hadn’t taken a proverbial hike on the day before Thanksgiving, and if local junkies hadn’t had their veins full of a particularly average batch delivered down from Montreal, and if there’d even been a smattering of crazy accidents or family disagreements involving carving knives, so that the skeleton staff working at the laboratory, as often is the case with commercial medical labs, had been dealing with something other than a clear and cloudless docket, and had been forced to wait an afternoon, or even into the evening, before processing Alice’s samples. If too much time had passed before the discovery that Alice possessed zero white blood cells,
zero.
If that same lab had discovered that slightly
above
fifty percent of Alice’s blood cells were cancerous, rather than the number they found, which was just barely below. If one of the top cancer hospitals in the Northeast hadn’t been available less than two hours away via ambulance—close enough that its doctors could apply their considerable expertise and equipment before more of those infected blood cells had replicated past the point of no return. If Alice hadn’t been isolated and her treatments hadn’t started before some random nearby person let loose with a stray sneeze whose germs had landed inside of her ridiculously compromised system, or before her pneumonia or fever had finished her off. Any individual clause in the list. Any offshoot of who knew how many other improbabilities. Any of the uncountable possibilities that happened to break her way when they could have easily broken the other way instead. If Alice spent a moment reflecting on any one of these, let alone all of them; if she so much as considered how lucky she’d been to make it to this moment
,
especially when she couldn’t allow herself to conceive of what she still had to go through—the ifs were enough to stop her cold.

Do not pursue the past,
she reminded herself.
Do not lose yourself in the future.

She needed to appreciate the now.

—

Day three: her nose swollen outward from the nostrils, her cheeks inflated. A deep crimson discoloration had started behind her ears and now covered the underside of her jaw, the top of her neck. “Not all that unusual for daunorubicin,” said the disheveled resident. “I don’t think anything for concern about,” added the visiting fellow (Mongolian, an emerging star, he’d been called in for a consultation).

The next morning, on rounds, the attending physician addressed those students who’d followed him into Alice’s room. Exclaiming his pleasure about Alice’s lack of a fever, he offered similar talking points about her newest rash (not at all unusual, no cause for concern). This one was a purplish shade, creeping out from under her pits, spilling in all directions. The attending possessed the good sense to keep his mouth shut about the possibility of the two rashes joining in a superrash. And no student doctor was brazen enough to broach the subject.

Alice took solace in the attending’s air of authority but also had a flash of sorrow for all the years she’d dismissed Dr. Glenn. “Ointments should take care of the burning,” continued the attending physician. He acknowledged the difficulty of keeping her hands still. Then, as if talking to a child, added, “Staying away from the rash is how we keep it from spreading or getting infected.”

“I’ll be good,” Alice answered. “Scout’s honor.”

Still she scratched. She picked. Oliver also noticed her running her hand over her hair. More and more she did it, like one of those poker tells. This concerned him—he wondered if a catheter had wriggled free from a weak or wandering vein in the crook of Alice’s right arm; if the IV drip was going into her biceps instead of her bloodstream. The resident, the fellow, and the attending were all sanguine. The infiltrating medicine was not a lethal mix; the swelling would recede. However, they also insisted: she had to keep that swollen arm stationary. And
still
she skimmed. Incessant, straight swipes with that same fucked-up arm, her fingers combing backward. To Oliver it now appeared as if his wife’s face was in the middle of transforming into a mutant boar’s; and watching her—ridiculously bloated, garishly discolored, frail, weak, covered in blankets, hooked up to all those goddamn tubes—all of that was bad enough. But here she was,
willfully and continually
disobeying doctors’ orders, running her hand over her skull, checking yet again, displaying each new wisp that clung to her finger.

“Nothing like the handfuls you’d expect,” she said. Her voice was hopeful, maybe even convincing. “I’ve heard stories—women who survived all sorts of chemo and kept a decent head of hair.”

The attending physician let Alice get it out of her system. Then he answered, plain as white bread: “It’s all going to fall out.”

—

Of course, Alice’s mom checked herself in to the nearby hospice. The white-haired woman who’d combed out Alice’s tangles, apologizing, always, for the pain she caused; who’d asked that Alice hold still, wrapped her hair into untold ponytails, and taught her girl how to braid, ending each lesson with a kiss on the top of the head
.
The hospice was available for loved ones of long-terms and potentially terminal cases, and charged twenty dollars a night, more than reasonable, thought Alice’s mom, especially with the lodgings being so homey: hand-stitched quilts and Americana on the walls, lace tablecloth and fresh flowers on the common table. Alice’s mother was calm and rational and not a complainer in any way, and she quickly proved indispensable, each morning finishing her grapefruit, cornflakes, and strong black coffee, then exchanging best wishes with the sad married couple whose son had been in a hunting accident, and then changing and re-dressing her grandchild.