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  “When are you going to get over that jerk?” he asked. “He also recommends all kinds of other bullshit.” Grant could feel his speech speeding up, one of the effects of the pills. A pressure buildup at the back of his brain forced the words out faster and with more emphasis. “I mean, raspberry açai supplements for weight loss?” He knew he should stop talking, but he couldn’t let it go. “Close your mouth and you’ll lose weight. It’s not fucking rocket science.”

  “What are you saying?”

  “I’m saying that if you just stop eating, you won’t be so fat.” He knew he’d gone too far, but he couldn’t help it.

  “What the hell, Grant? My sister bled into her brain, and you’re on my case to lose weight?” She tugged her sweatshirt down over her behind. “Your timing is impeccable.”

  “I was using you in the general sense, not you specifically. You know I love you just the way you are.” He said, trying to dial back his comments.

  “It certainly sounded like you were referring to me.” Tears gathered in the corners of her eyes.

  “I apologize,” he said.

  “Not so fast,” she said. “Your apology doesn’t erase the nasty things you just said.”

  “I wasn’t trying to be mean. It just came out.”

  “Maybe you should think before you speak.”

  “Forgive me,” Grant said. “Everyone’s stressed. When I go in today, I’m going to check on Alison and make sure Calvin’s got her work-up going.”

  “I need to know what’s happening,” she said. “She must be scared out of her mind.”

  He gave her a quick kiss, grabbed his shake and his keys from the counter. “I’ll keep you posted.”

  When Grant arrived at the neurology floor, he immediately checked the board. Alison had been assigned to the room the staff referred to as “the penthouse,” a large corner room with panoramic views of the Charles River and the Boston Museum of Science. This was the room he reserved whenever he operated on VIPs, but he didn’t think it would ease Alison’s mind to know that the King of Jordan had once stayed in that room after Grant successfully repaired a ruptured brain aneurysm.

  He sat down at the nurses’ station next to the floor clerk and opened the electronic medical record. The nurses buzzed around the floor taking vitals, dispensing meds, and finishing charts in time for the morning change of shift. When the food service cart rolled by, the smell of bacon traveled straight to his olfactory cortex, waking up his brain cells. He typed Alison’s name in and scrolled down past the results—blood work, chest x-ray, a consultation from one of the neurologists—until he found the report from her brain MRI. He held his breath while the report opened, then scanned down to the impression section.

  “Large arteriovenous malformation involving the left frontal and parietal lobes, measuring 5.1 x 4.5 x 6.2 cm, with large cortical draining veins and arterial supply predominately from the middle cerebral artery.”

  He clicked on the icon to bring up the images. The pictures looked even worse than the report sounded, the collection of tangled vessels occupying a large part of the left side of Alison’s brain and displacing the normal brain tissue to the right. He saw the small hemorrhage that had brought her in to the emergency room, but that was the least of her problems. At any moment, one of those abnormal vessels could rupture and cause a massive bleed, pushing her brainstem down out of her skull and killing her instantly.

  “Oh, fuck,” he said. He wasn’t surprised, but he’d been hoping they would get lucky, that the bleed would be from a small aneurysm or a benign tumor, not from an AVM the size of a fucking golf ball. He knew first-hand how tricky this condition could be to deal with, how quickly things could go south even in the most skilled hands. He stood up and started pacing back and forth.

  Kendra, the floor clerk, looked up from her computer. “Dr. Kaplan, watch your language.”

  “Not today, Kendra. Alison Jacobs is my sister-in-law.”

  “The nice lady in the penthouse? She seems okay. We chatted when she came in last night.”

  “She’s okay now,” he said. “But she’s got a huge AVM. It’s not an easy one to fix.” He sat back down at the computer and double checked the name on the top of the image to confirm this was indeed her scan. Her name shined back at him from the top of the screen.

  “Damn it,” he said, his legs oscillating uncontrollably.

  “Are you okay, Dr. Kaplan? You seem on edge this morning.”

  “It’s a crappy situation, Kendra. I don’t want to be in the middle of this. A six-centimeter AVM in an eloquent part of her left hemisphere.”

  “That doesn’t sound good,” she said.

  “It’s not good, and I know Dr. Shin isn’t going to feel comfortable dealing with it.” Cal was an excellent general neurosurgeon, but Grant knew from years of working together that this case would be too complex for him, the kind he would usually pass off to Grant without a second thought.

  Kendra took a sip of her coffee and turned back to the computer screen. “I’ll leave you doctors to sort that out,” she said.

  When Grant entered Alison’s room, Cal was at her bedside explaining the results, and Michael stood on her other side. Grant clapped Cal on the back and came around the bed to kiss Alison on the cheek.

  “Blondie.” Grant sat down at the foot of the bed. He’d been calling her this since Thanksgiving weekend in his senior year of college when he’d gone home to meet Cynthia’s family, the sounds of “Sunday Girl” and “Heart of Glass” drifting through her bedroom door. “This is the lengths you’ll go to get out of work?” he said.

  Alison smiled. She seemed relieved to see him.

  “I’m in the middle of explaining what’s going on,” Cal said. “Would you like to take over?”

  “Continue, by all means,” Grant said.

  “I was explaining that an AVM is not a tumor, but more a tangle of arteries and veins that’s not supposed to be there.”

  “If it’s not a tumor, then why is it such a big deal?” Alison asked.

  “It forms a mass that can push on important parts of your brain,” Cal said. “Also, the walls of the vessels are thin, so they can rupture and bleed without warning.”

  “That’s what happened yesterday?”

  “Exactly. Luckily, the bleed you had was a small one. Like a warning bell. Otherwise, you might never have known about this until it was too late.”

  “I don’t feel so lucky,” she said.

  Grant agreed that the word didn’t seem to fit. A ticking time bomb in the part of the brain that controlled movement of the right side of her body seemed particularly unlucky to him, especially since he wasn’t even sure of the best way to treat it. He’d handled his fair share of challenging cases over the years, and the results had not always been good. He still had nightmares about Mrs. Altimari, the little Italian lady who had stroked out while he was attempting to coil her aneurysm, and the look on her son’s face when Grant said there was nothing else to do, that hospice was the logical next step.

  “I guess it’s the way you look at it,” Cal said.

  “I live a healthy lifestyle,” she said. “I don’t smoke or do drugs, and I work out almost every day.”

  “Unfortunately, this can happen to anyone, at any time, regardless of how well you take care of yourself,” Cal said.

  “Working out can actually cause an AVM to bleed,” Grant said.

  “Oh,” Alison said. “So, what do we do now?”

  “To be perfectly honest, I’m not sure,” Cal said, looking over at Grant.

  “You’re not sure?” Michael said. “There must be treatment options.” Grant could tell by Michael’s silence until now that he was feeling overwhelmed with the situation.

  Cal didn’t respond, his eyes still on Grant.

  “It’s not a straightforward case,” Grant said. “The size and location of the AVM poses a challenge. Now that the bleeding has stopped, we have time to talk about different possibilities.”

 
“This isn’t my area of expertise,” Cal said. “If you were anyone else, I would be transferring you to Grant’s service. I’m going to do some research and figure out the best place to send you for further management. I think there’s a guy at Cleveland Clinic.”

  “This is one of the best hospitals in the country,” Michael said. “Why would we want to go to Ohio? There’s no place better than here.”

  “You’re right,” Cal said. “But the only person in Boston I would trust with my family member happens to be your brother-in-law.”

  “He’s also the best person for the job,” Michael said.

  “It’s a tricky situation,” Cal said. “He certainly could lose his objectivity if he chose to treat Alison. It’s not looked upon favorably.”

  “Dr. Richman in Cleveland is really good,” Grant said. “He gives all the talks at the national conferences. I’ll get you an appointment with him.”

  CHAPTER SEVEN

  Alison

  August 27, 2019

  SITTING ON THE EXAM TABLE in the physical therapy office the following day, Alison was surrounded by the same sad collection of people who were always here. Jared, the college kid on the rowing machine in the corner, had torn his ACL during a soccer match and was working to regain flexibility and get back on the roster. The elderly lady doing tricep extensions in the corner had suffered a small stroke a few months ago. Alison tried not to watch Thomas, the middle-aged man with early onset Parkinson’s disease, but his prominent tremor, shuffling walk, and flat facial expression drew her focus every time. Looking at him made Alison wonder if she evoked the same sense of pity in others.

  Svetlana finished with her last client and walked over to Alison. “What are we up for today?” she asked.

  Alison wanted to give an honest answer. Nothing. Nada. The big goose egg. That’s what she was up for. She would have preferred to lie in bed feeling sorry for herself, wallowing in misery and counting all of the things she’d planned to do with her life that would never come to pass. Alison had thought she would be so much better off five months after surgery. At the beginning, she had tried to maintain a positive attitude. She knew she had a long way to go, but she was determined to get there, little by little. As the weeks and months wore on with such slow progress, maintaining mental strength proved difficult.

  “No time for laziness,” Svetlana said. Sometimes Svetlana exhausted Alison to the point that she wished her dead, but her persistence had made Alison stronger, far from perfect, but definitely moving in the right direction.

  “Okay,” Alison said. To get through the hour of torture, she told herself it was basically the same thing as physical training at the gym. She had loved those sessions, looked forward to the way her muscles would burn after fifteen reps with heavy weight, the exhilaration of finishing a set of sprints, the way her trainer would yell at her to keep going and she would, the adrenaline shooting straight to her brain. Alison used to push through the pain, telling herself it was for her own good, but now, her motivation was lacking. At the gym, she saw results, her muscles more defined, her body leaner and stronger, but here it was so much more difficult to see the effects.

  Svetlana took off her sweatshirt so she was just wearing a tank top and athletic shorts. Alison would swear the woman was ninety-nine percent muscle. Maybe she’d been a wrestler or a rugby player back in high school.

  “Too … too,” Alison wanted to ask Svetlana if she was too hot, but her mouth wouldn’t form the word. She knew exactly how “hot” felt—the feeling of lying on the chaise on her deck in the summer sun—but she still couldn’t say it.

  “Getting ready to work,” Svetlana said, moving the walker off to the side.

  Supporting Alison under the arms, Svetlana used her weight to help her stand. “Today we start with a cane. No more walker for you.” She placed a cane in Alison’s left hand. It wasn’t a wooden cane like you would see in a Broadway show, or one of those with flowery designs elderly women used around town, but more of a no-frills practical cane. The black rubber handle looked like a bicycle handlebar and four prongs at the base created wide contact with the ground. Even though switching from a walker to a cane was a move in the right direction, having to use this kind of cane made Alison’s stomach burn, an obvious reminder of how far she still had to go.

  “This one is good for safety.” Svetlana pushed the cane from side to side, demonstrating how difficult it was to topple. “Very stable.”

  Alison grabbed the handle and held on for dear life. It felt strange to stand without the walker. The room seemed so much bigger than it had a few minutes ago, almost vast, the distance to the floor enormous. She imagined what it would feel like to fall, her shoulder hitting the ground with a loud thud, the pain shooting from her arm up to her neck. She’d become so accustomed to the secure feeling of the metal frame of the walker around her, keeping her safe, but also holding her captive, creating a barrier between her and the world.

  “You must learn the technique,” Svetlana said. “It’s different than with a walker. You use the cane in your good hand to support your weak leg.” She grabbed an extra cane from a rack along the wall and demonstrated, planting the cane at the same time as one leg and then bringing the other leg forward while the cane swung back.

  “See how the cane follows the natural motion of my arm? It shouldn’t feel awkward.”

  Easy for her to say. She had full use of her arms and legs; since Alison’s surgery, even the simplest tasks felt awkward. Things she used to do without a second thought—cutting food with a fork and knife, typing an email on the computer, blow drying her hair—were now impossible.

  “Try a few steps,” Svetlana said. “We can do this.”

  Alison wasn’t sure why Svetlana placed so much confidence in her. Yes, she’d shown up for all her appointments, mostly because Rhea insisted on it, but she hadn’t done anything particularly brave or impressive or inspiring. Maybe this was her moment to shine.

  Stretching her left arm forward, she anchored the base of the cane on the floor, but when she tried to advance her right leg, it refused to follow her command. With a lot of effort and writhing and grunting, she managed to drag it around, her toes dragging on the wood floor. Taking a step with her left leg proved easier, but then she had to start the whole cycle over again. She took a few more uncoordinated steps, each step so arduous, she wondered how Svetlana found the patience to watch this horrendous spectacle.

  “Good job,” she said. “Don’t be afraid to put some weight on the cane. Really use it.”

  “Alright.” Alison took a moment to breathe and gather her strength. One of the photographs on the opposite wall caught her eye, a woman wearing a numbered bib crossing the red finish tape, her arms raised above her head in triumph. She didn’t look like Becca—her dark hair was straight and her skin had an olive tone—but something in her expression still brought her to mind. Maybe it was the look of supreme determination behind her beaming smile, the same expression Becca got during a tough workout.

  “You ready to keep going?” Svetlana asked.

  No, not really, Alison thought, but she didn’t want to disappoint Svetlana. After a few more steps, her quadriceps muscles started to burn, like when she used to do barbell squats, but there was no accompanying sense of satisfaction. She stopped for another breather and looked again at the photograph. She couldn’t fathom the sense of personal victory that woman must feel at finishing the grueling race. Alison’s marathon had just begun. There were at least twenty more miles left to run and she was already totally spent. Maybe it was her eyes that reminded her of Becca. They had the same mischievous glint that Becca use to get when they were planning a quick rendezvous in the staff lounge.

  Her breathing slowed, but suddenly she felt light-headed, the walls further away, the line where the walls met the ceiling strangely wavy, the photographs on the wall off kilter. The bright colors in the photo blurred and swirled into a muddy brown, and she felt the warmth rush from her head, a sudde
n nausea.

  “Are you okay?” The look on Svetlana’s face heightened Alison’s anxiety. She stepped behind Alison and helped her over to the exam table, using a towel to dry her neck and chest.

  Another therapist came over. “What happened?”

  “She was doing great,” Svetlana eased her down and placed two pillows under her legs. “It must have been too much all at once.”

  “I’ll get an ice pack and some juice,” the other woman said.

  When she left, Alison looked up at Svetlana and lost it, the sobs escaping in ugly bursts and gasps. The tears ran down the sides of her face onto the exam table, wetting the neck of her shirt. The more she tried to reign in the tears, the more they flowed. Even with all of the ups and downs, this was the first time she’d cried since her surgery.

  Svetlana patted Alison’s face with the towel. “What happened?”

  “I …” Alison wanted to be a good patient and prove herself, but it was too much, too soon. She was embarrassed that taking a few steps was so excruciating while Jared over on the rowing machine would be scoring goals again within a few months. People used to have trouble keeping up with her in spin class, and now she couldn’t walk across a room without taking multiple breaks.

  “It’s okay. Just rest for now,” Svetlana said.

  The other therapist returned and placed an ice pack on Alison’s forehead. The chill centered her, calming her queasiness.

  “Her color’s coming back,” she said, moving the ice pack from her head to the back of her neck.

  “Should I give your husband a call?” Svetlana asked.

  Alison shook her head. If Svetlana called Michael at work, he’d show up all annoyed and distracted, the last thing she needed right now. Really, she wished Becca could be here encouraging her with her sweet smile. She’d know just the right thing to say to make Alison stop feeling sorry for herself, to make the glass seem half full rather than half empty.