Stolen (2 page)

I had reason to be concerned. Mountaineering exposed climbers like myself to a greater degree of ultraviolet radiation. I had studied up on the latest gear, lotions, and trends for delivering maximum sun protection. I had also learned to detect the signs and symptoms of skin cancer—asymmetrical growth, ragged edges, nonuniform coloration, and a large diameter. The oddly shaped mole on the underside of Ruby’s foot, about the size of two pencil erasers, was far larger than the quarter-inch safety limit. What I didn’t know, and what Ruby couldn’t tell me, was if the area of concern had grown in size, and if so, how quickly it had evolved.

“John, you’re really starting to freak me out,” Ruby said, pulling her foot away from my lengthy and silent examination. “What are you thinking?”

I moved in close to Ruby, cupping her flushed cheeks in my hands.

“I think we need to call a doctor, just to be safe,” I said. I made sure my voice sounded soothing. “But I also think that everything is going to be just fine.”

Ruby looked me in the eyes and strained to smile.

We’ve been married five years, and we dated for an equal amount of time.

She could always tell when I was lying.

“T
he cancer has spread.”

The doctor’s words hung in the air like an oppressively humid day, sucking up all the oxygen in the antiseptic examination room.

“The cancer has spread.”

This was the culmination of a three-week journey that had begun with Ruby’s first-ever visit to a dermatologist. The initial tests had come back positive for cancer—melanoma. Only we didn’t know how bad it was or how much it had spread throughout her body. We were referred to a dermatological oncologist, who scheduled Ruby for a CT scan. Then we had to wait.

Ruby sleepwalked through the days following her initial diagnosis. We simply couldn’t wrap our heads around what it really meant for our future. Make a checklist for a nervous breakdown, and we’d have all the symptoms. Panic? Sure. Crying easily? Of course. Upset stomach? Exhaustion? Check and check. We were trapped in a brutal, unrelenting anxiety loop.

“Shit, shit, shit!” Ruby would sometimes blurt out. “Shit, shit, shit!”

Dr. Lisa Adams, our pale-skinned dermatological oncologist, perhaps a decade older than Ruby, revealed the results of the CT scan without being overly emotional.

“I’m afraid there are some suspicious nodes in the groin,” Dr. Adams said to Ruby.

In my mind “suspicious nodes” had the ring of a death sentence. Ruby gripped my hand tighter. The diagnosis threw me into a dull fog. I was too numb to process everything, and much of what Dr. Adams said next passed right through me.

“Unfortunately, the cancer has spread. . . . The melanoma appears to be stage three. . . . We have the results of the biopsy from the growth on your foot. . . . Cancer is caused by a BRAF gene mutation . . . treatment available . . .”

Her words tumbled about my head. I sensed the coming hurricane of information overload that would carry us off to a foreign country where we didn’t speak the language—an alphabet soup of terms, treatments, and genetics.

“I’m twenty-eight years old,” Ruby said to Dr. Adams. “I’m too young to have stage three cancer.”

“I wish that were the case, Ruby,” Dr. Adams said. “I really do.”

“Am I going to die?”

“This is a treatable condition,” Dr. Adams replied. “We’ll start the drug treatment first and gauge how well the nodes are responding. If we do get a response, then the nodes have acted as a ‘marker’ that will help us determine how responsive to the drug you’ll be. If you don’t respond to the drugs, then a surgical procedure called a node dissection becomes essential. Surgery would likely follow even if you do respond completely to the drug, as there would likely be some microscopic cancer left in the nodes. Does that make sense?”

If it did, Ruby didn’t say. She clearly had other things on her mind. “What’s the survival rate? Please! Am I going to die?” Ruby’s last question was punctuated by a choking sob.

I embraced my wife, shuttering my eyes to hold back my own flood of gathering tears. Ruby needed me to be strong for her, present and positive.

We were talking about the vacation we going to take once we had this thing licked. Ruby was hinting at starting a family.
Now she’s asking about living—survival rates! It’s not fair. No, this isn’t happening to us. It’s not real. This is not happening!

“I love you,” I breathed into my wife’s ear.

Adams waited for the right moment before answering Ruby’s questions.

“We’re going to do everything we can to make sure that doesn’t happen,” said the doctor. “And I’m going to help you every step of the way. The tough part is that I can’t beat your cancer for you. We’re going to have to battle this together.”

“How did it progress so fast?” Ruby asked. “Can’t we just cut it all out? How did I get it on the bottom of my foot? What’s the drug treatment?”

Dr. Adams listened intently to Ruby’s rapid-fire questions. She studied everything about Ruby’s gestures, vocal intonation, and expressions, much like a psychotherapist conducting an assessment of a new patient. I figured that in addition to answering Ruby’s specific questions, Adams needed to ascertain how much information to share and what should be revealed in future discussions.

“Unfortunately, there is no curative therapy for most metastatic cancers—that is, a cancer that has spread to other parts of the body.”

“What do you mean by no curative therapy?”

“We need to focus on the containment strategy I outlined for you.”

“Why?” Ruby asked, pleading really. “Why is this happening now?”

“I wish I could say, Ruby,” Dr. Adams said. “Most skin cancers are not hereditary, but there are certain cases where a parent with a certain type of skin cancer increases the average risk of getting a cancer yourself. Still, I would lean toward ruling out familial melanoma—”

“My mother basically lives in the sun,” Ruby said. “She’s never had any problems.”

“But I couldn’t claim that as fact,” Dr. Adams said, finishing her thought.

Adams referenced Ruby’s file. I suspected she was double-checking the family history—what little Ruby knew of it, anyway. In those pages, Dr. Adams would find reference to a father who died of a heart attack when Ruby was eleven, a few uncles and aunts who suffered a variety of ailments, none of which were melanoma or cancer of any kind.

“Even with further testing, I can’t promise that we’ll be able to figure out if a specific environmental factor is to blame for the mutation. And speaking honestly, the
why
isn’t as important right now as the
what,
meaning what we are going to do to fight your cancer?”

“I want you to tell me everything about my cancer,” Ruby continued. “Don’t hold back. I mean it. I want to know it all.”

Ruby sounded definitive. I interpreted Dr. Adams’s change of expression as one of pleasant surprise. She didn’t know Ruby’s fighting spirit. If one thing gave me hope, it was my wife’s tenacity and willpower. Both, I believed, would be as healing as the cancer was deadly. Ruby could get a Christmas present in summertime and wait six months to open it. She can keep the one-cookie promise, and I’ve never once heard her hit the snooze button. Yeah, she’s got willpower, all right.

Dr. Adams spoke for fifteen uninterrupted minutes. She explained the gene mutation in greater detail and walked us through the recommended course of treatment. She spent some time talking about the node dissection and what Ruby should expect after her surgery. We listened with rapt attention. My head would occasionally nod my understanding, while Ruby’s didn’t move.

“The drug therapy I’m going to recommend has been highly effective in treating your type of cancer.”

“What’s the survival rate?” Ruby asked again.

Somehow, the doctor managed to skirt that question. “I really can’t say definitively,” Adams replied.

“Best guess,” Ruby said.

“A lot of variables go into factoring survival rates.”

“The number, Doctor, please,” Ruby said.

I could tell Dr. Adams swallowed this part of her job like bitter medicine.

“We think of survival rates in terms of a five-year time span,” Adams said. “But this doesn’t mean the patient has become cancer free within that time period. It could mean they’re now disease free, or it could be they’re progression free. What it means is that five years after they start treatment, they’re still alive.”

“My number.”

“Twenty-five percent,” Adams said. “If we don’t start treatment right away, that number could drop precipitously.”

Now it was my turn to swallow that medicine.

Twenty. Five. Stinking. Percent.

“Here’s where it gets a bit tricky,” Adams said, speaking in a voice that suggested “a bit” meant “a lot.”

I could see that Ruby was still trying to digest the 25 percent figure.

“How could it get more tricky?” she asked.

“The generic form of Verbilifide, the drug therapy you need, is currently out of stock.”

“When will it be back
in
stock?” I asked the question as if the drug were some part that could be ordered and picked up at Home Depot.

“I can’t tell you that.”

“What the heck! Why not?” Ruby asked.

“It’s just unknown,” Adams said, her voice tinged with frustration. “The manufacturer sent out an alert last month. They’re way behind on supply orders. To be honest, they’re not the only ones. Call any oncologist and they’ll tell you that we’re currently in the midst of the worst shortage of generic cancer medications that we’ve seen in decades. It’s a historic supply crisis with tremendous repercussions for both patients and their doctors.”

“What do we do?” Ruby asked. “My survival hinges on starting treatment right away!”

“Verbilifide isn’t in short supply, just the generic,” Dr. Adams said, sounding reassuring. “We’ll have to prescribe you the brand name, that’s all.”

“So that’s not a problem, then,” I said.

“The generic costs a fraction of what Verbilifide will cost for a full course of treatment.”

I asked, “Meaning?”

“Meaning it will cost around three hundred thousand dollars.”

Ruby and I both looked sticker shocked. It’s bad enough confronting a cancer diagnosis, but to think about the financial implications conjures up the old “insult to injury” adage.

“I guess we can’t just go to CVS to pick up the drugs,” I said.

Ruby laughed, which almost made me cry.

“No,” Adams said. “I’ll need a week to order Verbilifide from a specialty pharmacy. They’d have the drug delivered to my office, and you’ll need to pick it up here. Just so I’m clear, you’re not worried about the cost?”

I shrugged off the number.

“Why worry about that?” I said. “That’s what health insurance is for.”

F
rom the bedroom, which doubled as a cramped home office, I opened a Safari browser on my MacBook Pro and typed the URL for my bank’s Web site. Afternoon sunlight spilled into the room from two windows, which the building’s superintendent kept promising to clean, while a steady breeze fluttered the curtains, casting movable shadows on the scuffed hardwood floor. Ginger, the orange tabby cat Ruby had adopted from the ASPCA last winter, perched herself on my lap and purred her pleasure. Her head darted all about, on a mouse hunt perhaps, as we’d had quite a few recent sightings. Not that we lived in a total dive, but this wasn’t the Ritz, either.

Seeing nothing of interest, Ginger opted instead to stick her head inside my water glass. Reflexively, I tilted the glass, allowing Ginger a drink, because that was what I’d done a thousand times before. Ginger had grown accustomed to drinking water out of a glass, and we hadn’t the time or inclination to break her of this curious habit. Meanwhile, my left hand deftly keyed in the username and password combination for my bank account. Ruby hovered close behind, scratching Ginger’s orange head while her kitty drank.

“How much is in the checking account?” Ruby asked.

I clicked. Then I clicked again.

“Two thousand,” I said. “Give or take a thousand.”

Ruby grimaced. “What? Why are we so low?”

“Um, let’s see. We’re down to one income, which after business expenses, food, taxes, car payment, my school loan, your tuition, and utilities . . . leaves us with just about zero every month.”

“Oh, goodness.”

Ruby didn’t ask me about our savings account. She knew I had drained it long ago to climb the Kang. “Live the life you want to live today,” is what Ruby always preached. It’s one of the reasons I loved her so much. She didn’t just support my passions—she actually got me.

Today I just wanted Ruby to live. It’s funny how life gets really centered, and really quickly, too, when you’re forced to confront what’s truly important. Each day, each moment Ruby and I had together, her health, her comfort, that’s what I cared about now. That’s all I cared about. I reached over my shoulder and grabbed hold of her delicate wrist. Ginger, surprised by the sudden movement, leapt from my lap and onto the floor with a soft meow.

“Don’t worry,” I said. “It’s going to be fine.”

“Do you know how much our insurance is going to cover?”

“No. But I have a call in to Atrium. They should be calling back soon. We’ll figure it all out, I promise.”

Ruby sighed and flopped down on the bed—technically, just a mattress and box spring on the floor. Bed frames were for grownups, she once said. I admired her from my desk chair, taking in every detail like a slow, calming breath. Ruby, beautiful and lithe, fit her surroundings the way a tiger blends into the jungle. I had ceded all apartment-decorating decisions to my wife. The furniture came from various consignment shops. The color scheme, turquoise and white, evoked a feeling of living in a beach cottage, because that was where she longed to be—an ocean community, replete with artsy people who valued acupuncture and holistic healing. Clutter, she kept to a minimum. Everything about our home was peaceful, like Ruby before her disease.

“You know what’s weird?” Ruby said as she gazed absently up at the cracks in the ceiling, her arms bent at the elbows, hands interlocked and resting behind her head. “I don’t feel sick, just tired.”

“Hopefully, after that drug, we won’t have to know what cancer feels like.”

Ruby sat up and got cross-legged on the bed. “That drug sounded worse than the cancer.”

“That drug is the most important thing in our lives.”

“Liver problems. Irregular heartbeat. Skin rashes. Upset stomach. Fuck this, John. I mean it. Fuck having fucking cancer. I can’t stand it.”

I got up from my chair and plunked myself down on the bed beside Ruby. I put a hand on her knee but knew not to hug her. Ruby could be like Ginger that way. At times she wanted to be petted and scratched; other times she was too prickly to be touched. But I kept my hand resting on her knee, knowing she’d eventually cave in to wanting comfort. When she fell against my chest, I wrapped her in my arms and wouldn’t let go.

“Are you ready to tell your mother?” I asked, brushing Ruby’s hair from her face and eyes.

Ruby pulled away and sighed. “Sure,” she said, “but I’m not expecting anything.”

“She might surprise you,” I said.

“How? By getting sober and buying a plane ticket?”

“Something like that.”

Ruby shrugged off her mother the way I had the cost of her medication.

“I won’t hold my breath.”

The phone call from Atrium came an hour later. Ruby was fast asleep in the bedroom, cocooned within a burrow of blankets. Ginger was nestled up next to her and making that super-loud “I’m the happiest cat in the world” purr.

The agent from Atrium, a whiny-sounding man, introduced himself as Leonard Tate. “How are you doing this afternoon?” he asked.

I thought he sounded young—maybe just a few ticks past his frat party years. I told him what was going on with Ruby and how her doctor was going to prescribe her a course of treatment for Verbilifide.

“I’m sorry to hear that,” Tate said, not sounding all that sorry to me.

“I wanted to make sure that everything checks out okay for my wife’s treatment as far as our insurance coverage goes before we start,” I said.

“Of course,” Tate said.

The line went uncomfortably silent. I could hear fingers tapping away at a keyboard. He seemed to make an impossible number of keyboard clicks for the information he’d set out to retrieve.
Clickety-clack. Clickety-clack.

Following an interminable amount of time, Tate asked for my health insurance account numbers, which I already had given to the annoying phone tree disguised as Julie, a saccharine-sounding computerized agent who couldn’t have been less helpful if she spoke only Yiddish. I didn’t bother asking Tate why Julie couldn’t pass along my account numbers to a living, breathing person. It’s been my experience that most large companies have antiquated technologies. And Atrium, both large and anonymous, trumped all other insurance companies with the lowest customer satisfaction ranking according to Ranker.com, which compiled such lists from actual customers. The Internet was a powerful equalizer that way. If you failed to meet customer expectations, you’d be sure to hear about it. Atrium knew to offset their prickly corporate culture and rankled consumer base with the lowest rates going. The bottom line was, we couldn’t afford better insurance coverage.

Tate keyed in the numbers as I read them. More silence. More fingers tapping away, but this time I could hear Tate make a couple deep sighs—disconcerting, to say the least—immediately followed by yet more finger tapping. I imagined Tate was seated inside a cubicle somewhere. Maybe he had a plant on his desk. A picture of his girlfriend, perhaps. Did this stranger understand the importance of our conversation? Did he realize lives were at stake? Could he relate to me as more than just a health insurance account number on the other end of his headset?

The answer, according to Ranker.com, left little doubt.

“So, Mr. Bodine, I’ve pulled up your health-care policy, and I’m afraid there’s a problem with the coverage.”

I felt the floor drop out from underneath me. “What do you mean, a problem? My payments are automatically deducted from my bank account,” I said.

“This isn’t an issue with the status of your coverage. That’s not in question.”

“Then what is?”

A creeping sense of dread started at my toes and began to inch its way up through my body.

“Your plan will not cover the cost of Verbilifide, because there’s a generic alternative available,” Tate said.

My loud and relieved sigh made Ginger look, though Ruby, still buried beneath her many blankets, didn’t budge.

“For a second there I thought we were going to have a real problem,” I said. “The generic drug for Verbilifide isn’t available,” I explained. “You can check that with Ruby’s doctor if you need confirmation.”

“Yes, well . . .” Tate hesitated in a way I didn’t like one bit.

“Yes, well, what?” I said.

“The actual availability of the medication isn’t the issue as far as our policy is concerned. Technically, there is a generic alternative.”

My pulse started jackhammering away, and I knew my voice would waver if I tried to speak. I felt my face flush as I attempted to swallow down a simmering rage.

“It’s not available,” I said, speaking the words loudly, as if maybe that would aid his comprehension. “It’s out of stock.”

“Yes, well, when it gets in, it will be covered—minus your deductible, of course.”

“Minus my . . . when it gets in stock . . . What . . . what are you trying to say?”

Thank goodness for cordless phones. Not wanting to wake Ruby, I left the bedroom, anticipating the volcanic eruption to come.

“I’m sorry, but this is the policy. We don’t cover brand-name drugs if there is a generic alternative.”

“It’s not available, Mr. Tate!” I shouted into the phone, squeezing the handset so hard that my fingers ached. “How can my wife take something she can’t get? Tell me, how is that possible?”

“I understand that you’re upset,” Tate said.

“Upset? Upset? No, upset doesn’t even begin to cover it. Are you telling me that my wife and I are on the hook for a three-hundred-thousand-dollar course of treatment?”

“Unless you take the generic,” Tate said.

“I can’t get the generic! I can’t get it! What part of ‘it is not available’ don’t you understand? How is this not getting through to you?”

A steely bolt of anger revved inside me, threatening to explode in a vitriolic tirade unless I paced the room.

“You elected to have the most inexpensive policy,” Tate said.

“There are a number of constraints to your drug coverage.”

“I elected to have the most inexpensive coverage because that’s all I could afford. The monthly premiums are already ridiculously high. For what? What in the hell am I paying you for?”

I heard footsteps behind me and whirled at the sound. Ruby ambled out of the bedroom, wrapped in a snuggly blanket. Her hair stuck out at odd angles, and she seemed unsteady on her feet. I cupped the receiver with my hand.

“What’s going on?” she croaked out.

“Nothing, babe,” I said. “Just talking with our insurance company. Minor hiccup. I’ll get it all worked out.”

“Well, keep your voice down,” Ruby said, feigning an irritated tone. “You’ve got to let a sick girl get her rest.”

“I’m sorry,” I said.

“So sorry that I was such a fool,” Ruby sang, soft and sweetly.

She held up a finger. Another point. I recognized the melody from a classic country tune but didn’t recall the artist. I smiled weakly, giving Ruby’s forehead a mollifying kiss. Meanwhile, I’m thinking,
We’re screwed.