Symptoms of a Heartbreak Read online

  “Hello,” he says, then pops the earbuds back in, his eyes settling back onto the screen.

  “Lovely to meet you,” I say. “I understand from the file that Brendan is one of my mom’s patients?”

  Ericka nods. “And I was, too, before him.”

  “Yes, dear,” Ms. Ruby adds. “We’ve been going to your mama since my own babies were born. Your mama’s like a member of our family.”

  My phone starts buzzing and I rush to silence it. Cho shoots daggers at me, his eyes tattling. “If I recall correctly, you’re the maker of those amazing sweet potato pies we get every Thanksgiving.”

  Ms. Ruby laughs again, and it’s lovely. “That would be me! Ericka’s got no baking skills—she’s too busy lawyering—but Brendan here’s been apprenticing with his grandma, reluctantly.”

  “Back to business,” Ericka interjects. “Dr. Sehgal—your mom, I mean—says we caught it early and that perhaps things are salvageable.”

  “He was barely eating, and when he did, he couldn’t keep anything down, not even water,” Ms. Ruby says. “Complained about stomachaches. Poor boy. Got so bad he couldn’t go to school for days on end. We spent a lot of time praying on it. And he was already a skinny little thing. Look at him now.”

  Brendan focuses harder on the screen—I see flashes of an old Power Rangers cartoon. He hasn’t said more than a word the entire we’ve been here. I make a mental note to try to chat with him one-on-one.

  “Why don’t we step outside so we can discuss some options,” Howard says, and the group follows her to an office suite.

  Ms. Ruby trails behind her, still talking. “Then we found the swelling. It was bad.” Ms. Ruby turns to me. “Dear, your mama said you’d take good care of my grandbaby, and I believe her.”

  “Of course, Ms. Ruby,” Howard says, hiding annoyance. “The main treatment for lymphoma is chemotherapy, which is intense for the patient—and for the family. Because his cancer is spreading quickly, we need to move fast. There will be four phases of treatment: first surgery to remove the growth; then radiation treatment and chemotherapy to eradicate any future growth; and then maintenance. Unfortunately, this may take several years, and it’s not an easy process. But we want to make sure we get it all and prevent recurrence.”

  “Years!” Ms. Ruby says, and her eyes go misty. “My poor boy.”

  Ericka frowns at her mother but doesn’t say anything.

  “He’s in good hands here,” Howard says. “And he has a loving support system at home—which is critical.”

  “That he does,” Ms. Ruby says. She takes my hand, and Howard’s. “Thank you for taking this on, my dears. I know it seems like Brendan isn’t listening, but he’s absorbing everything. It’s too much for him.” Then she hooks a finger under my chin, lifting it. “And you, sweetheart, you’re the spitting image of your mother. With you, he’s gonna feel safe.”

  I nod, and we say our goodbyes—for now. “We’ll be back later this afternoon with further information about Brendan’s treatment plan,” Howard says. “Brendan’s got a long road ahead of him. So for now, the best thing he can do is get some rest.”

  That’s definitely what he needs. But as I steal one more glance at Ms. Jackson and her frowning daughter, I sense some familiar mother-daughter tension simmering between them. I don’t think this case (or any of them, really) is going to be as straightforward as it seems.

  CHAPTER 7

  I quickly check my phone as we follow José to the second suite. Lizzie, as suspected. Sending me pictures of her new bathing suit. “Saira, this one is all you, so if you could focus, that would be appreciated,” Arora says, and Cho nearly guffaws.

  Guiltily, I stash my phone. “Of course, Dr. Arora. Alina Plotkin, age twelve, facing acute leukemia.” Which is what Harper had. And died from. I swallow hard, bracing myself.

  “Transferred over from Philadelphia Children’s because her family is supposed to be back at work and school this week—”

  “That’s not really relevant, is it?” Cho interrupts, but Arora shakes his head.

  “That’s the thing about oncology,” he says. “You’re not only dealing with a sick kid—you’re treating the whole family. Because they’re all dealing with the fallout of the diagnosis, and that can take a heavy toll on a family. So while technically it’s not ‘pertinent,’ it is something to note.”

  I continue, my voice steady, as if Cho hadn’t interrupted. “Alina’s cancer was caught early, thanks to a sunburn issue this summer, and the prognosis is strong,” I add. “Suggest straightforward approach of chemotherapy followed. So the standard procedure in a case like Alina’s—which we’ve caught relatively early—is to begin with chemotherapy and see how effective it is before we consider other options, which might include targeted testing and trial-run medications to reduce growth, surgery to remove the affected cells, and in some cases, stem cell transplants, which is a newer methodology we can certainly discuss. Beyond that, worst case, would be radiation.”

  Arora nods in approval. “All right, let’s go.”

  As we enter the room, Arora stands beside the bed, holding a chart and chatting with an older, balding man. The dad, likely. He smiles at our little group, then takes a small step back, settling into observation mode.

  She’s small and blond, with cherub cheeks and bright blue eyes—a baby face that makes her look much younger than the twelve years her file claims. She smiles when we walk in, big, white Chiclet teeth fill her tiny mouth. It’s a wide, misfit grin that reminds me of Harper’s, whose grown-up teeth hadn’t even finished coming in before she died.

  As we gather around the bed, she sits up straight, careful that her cotton medical gown isn’t revealing too much. I remember watching Harper do the same thing when she used to come here.

  “Hi there, lovely! I’m Nurse José,” José says chirpily, walking right up to the girl and arranging pillows and blankets to give us easy, discreet access to the patient. “You must be Alina.”

  The girl beams at him, then looks to me, her eyes curious. I probably don’t look all that much older, to her at least. Even though she seems like a baby to me.

  “And I’m Dr. Cho.” He sticks his hand out to the father, who shakes his hand firmly. “I’ll be part of the team taking care of your daughter.”

  Howard introduces herself, too, and then the man turns to me. “And what are you, a candy striper?”

  I want to hit him.

  “If I am, I’m definitely wearing the wrong outfit,” I say with a laugh. But no one quite gets it.

  “I’m Dr. Sehgal,” I say to the man, whose face wears what I presume is a permanent grimace. “Another intern. I’ll be the part of the team handling Alina’s care here at Princeton Presbyterian, and the primary resident on her case.”

  “No, I think there’s been a mistake here. We were told that Alina would have the best doctors in the country. I don’t think a teenager qualifies.” The man’s frown deepens.

  I make my voice as strong as possible, despite Cho’s not-so-discreet sneer and Howard’s worried frown. Arora looks concerned, too, but doesn’t step forward.

  “I assure you, Mr. Plotkin, that your daughter will receive the utmost in care here at Princeton Presbyterian.” I put on my warmest smile. “I’m part of a carefully vetted team, and between us, we’ve got degrees from Princeton, Georgetown, and Yale, and training in some of the finest medical programs nationwide. I graduated top of my class at UMDNJ, in their prestigious seven-year program, completing it in four. I have a photographic memory, which means I can recall every single detail of everything I’ve ever read or procedure I’ve seen or done. I’ve also completed preparatory rotations at private facilities, including Princeton Pediatrics & Adolescent Care, and served on Doctors Without Borders missions for two summers and counting. I’m also dedicated, focused, and well versed in the literature in oncology, as I’m preparing for the boards already. And because I’m closer to your daughter’s age, I promise you, I understand what she�
��s going through.”

  “Listen, kid, you may have the MD or whatever, but this my child’s life on the line here,” Mr. Plotkin says, still frowning. “We need the best. That means experience.”

  “Yes, I understand. But I have experience. In fact, she reminds me a lot of my own best friend, who had cancer and was treated at this very hospital.” I pause for a second and swallow hard. Part of me wants to pull out that tattered photo of Harper from its spot in my back pocket. But that might cause tears: “I helped diagnose her.”

  José pumps his fist in the air on the other side of the bed, and Alina looks up at me, her smile hopeful. Harper’s face flashes in my head.

  “I’d really like it if you could stay,” Alina says, soft but determined. “Actually, if all of you could stay. I want to hear my options. I want to be involved. Okay, Dad?”

  Her father looks startled but nods.

  I smile at Alina and then turn to the father. “I looked at your daughter’s chart and came prepared to discuss some new and advanced strategies that may be highly feasible and successful in a case like Alina’s,” I continue, my voice strong and steady. “However, I understand if you’re not comfortable with me here. If you’d like me off the case, I can step outside right now.”

  The man touches his forehead. “No, I think we should proceed. Alina’s right—she needs someone who knows what she’s dealing with. And your background is certainly impressive. For a teenager.” He smiles at me in apology.

  “Thank you, sir.” I smile back. “Let’s get started, then.”

  As Cho and Howard make notes at the monitor, I walk over to Alina’s bedside. She’s barely five feet tall, and her pale white skin is marked with blue bruises. She’s got a broad forehead like her father’s, and round cheeks that will probably slim down into high cheekbones with age.

  “How are you feeling, Alina?” I ask her.

  She shrugs. “I’ve been tired, and I kind of want to go back to school. It gets boring being in the hospital after a while.”

  “Have you been in pain?” I ask. “Could you tell me how much, on a scale of one to ten?”

  “Define the scale—like a banged-up knee is one, and having your tonsils out is ten?”

  “Have you had tonsillitis?” I ask her.

  She nods. “When I was little—like eight. It was the worst. I had, like, a sore throat for a whole month. Then I got to eat lots of ice cream.”

  I grin at her. “Well, there’s this really awesome ice cream place called Thomas Sweet’s down the street from me—maybe we can get you a pint when you’re feeling better.”

  “Maybe,” she asks, a thoughtful expression on her face. “What’s your favorite flavor?”

  “Peach in the summertime and candy cane in the winter. What’s yours?”

  “Strawberry cheesecake.”

  “I’ll make a note of that on your chart,” Howard says, and we both laugh.

  Cho clears his throat. “Can we get on with it?”

  “Yes, I’d like to hear about the treatment options,” Alina’s father says, his voice stern and rough, like my old organic chem professor’s.

  “Yes, sir,” I say, then cringe at my use of the word “sir.” “I mean, of course. So the standard procedure in a case like Alina’s—which we’ve caught relatively early—is to begin with chemotherapy and see how effective it is before we consider other options, like surgery or radiation.”

  “Yes, well, hopefully it won’t get to that,” Alina’s dad says with a laugh that slowly turns into a cough. Then all his words come out in a rush. “We’ve got other kids at home—that’s why my wife’s not here, actually—eight-year-old twins, and we thought it best not to expose them to all this, if we can. We’ll be trading off, you see, and I want to make sure Alina is comfortable, and that, despite her being here, treatment remains as painless and manageable as possible. Her bubbe may come down from Brooklyn to help, if that’s necessary, as her mother can’t lose any more time from work. We know the prognosis is good—at least that’s what they said in Philadelphia. We’ve never dealt with anything like this before, and hopefully won’t again.”

  “That is the hope,” I say flatly. The prognosis is strong, straightforward. But the flash of Harper’s grin on Alina’s face reminds me that it’s not always so easy. We’re not allowed to say that, even though it pinches me to keep the bright white of the lie going. “And of course we’ll do the absolute best we can. One other thing we can explore—”

  Arora steps forward at exactly that moment—the wrong moment—and says, “All right, guys, let’s wrap it up.” Like it’s my first day scooping ice cream or something.

  “Yes,” I reply. “We’re about ready to begin Alina’s blood work, aren’t we, Dr. Cho?”

  Cho waves toward José, who brings over a fresh, sterilized workup kit to get things moving. Howard hovers too close.

  My phone vibrates again, wrecking Cho’s concentration, and he glares at me as I fumble to silence it. Once it’s quiet, he turns his attention back to Alina and the needle.

  Nurse José sets up the blood tubes, and prepares the needle and IV, Cho watching the intake as I watch the monitors to make sure Alina’s doing okay.

  “Okay, Alina, I know you’re an old pro at this by now. Dr. Cho’s going to start the blood work. You can hold my hand while he does it, if you’d like,” I say, offering it. “I always prefer that when I’m getting shots.”

  She takes my hand and smiles. “Okay,” she says. “Thanks.”

  “So,” I say, distracting her, distracting myself. “Strawberry cheesecake, huh? In ice cream? I’ve never had it.”

  “I’ve always stuck to plain old chocolate,” Howard adds. “Maybe with rainbow sprinkles. You’ve got a sophisticated palate, kid.”

  “Yeah, I want to be a chef when I’m older,” Alina says, “so I like to try all different kinds of food. When I can keep it down. Strawberry cheesecake is amazing, and they’ve also got blueberry in season.”

  “Have you ever had lychee?” I ask. “I had it at this fancy place in DC on one of my Hopkins trips and it was like this slow-churned fruit and cream—”

  Cho clears his throat, pulling the needle and closing the tubes. “Well, that was easy, wasn’t it, Alina?” Cho says, swiftly labeling each one with Alina’s details. “We’re all done.”

  “You’re a pro,” I tell Alina. “We’ll get this blood work done and then figure out a plan. In the meantime, I’m going to monitor how you’re doing on the current schedule of meds. Anything bothering you right now?”

  “The blue ones make me nauseous, I think,” she says in a voice that’s tentative, unsure she’s allowed to complain. “The yellows were better. The other doctor said they weren’t strong enough.”

  “Unfortunately, there’s not much to be done about that,” Cho starts in an unforgiving voice. “The pills you’re on were carefully calibrated to ensure that you’d be getting the right combination of medications to address the growth—”

  “Actually, Dr. Cho,” I cut him off, “can I talk to you for a minute?” I gesture to the hallway. I wave him out of the room, taking Alina’s chart with me, doing math in my head.

  Howard steps out and looks at me, incredulous.

  “We may be able to fix that.” I show them the chart. “We could swap back, try a different antiemetic, increase liquids and simple sugars to get the same impact without as many side effects.”

  “No way,” Cho insists. “She needs the anti-nausea meds to get through it. Without it, she would—” I know what he’s thinking. This one should be simple, but it’s the complications that could cause trouble.

  Howard interrupts. “No, Saira’s right. That could totally work.”

  “It’s too big a risk,” Cho says, looking from me to Howard and back again. “She’s already deteriorating. You’re putting her life on the line.”

  “It’s a risk worth taking,” Howard says, her voice low. “And she’ll be more comfortable in the meantime.”


  Cho shrugs. “The insurance is going to balk. You watch. You can talk to Arora, but keep me out of it.” He glares as he’s heading back into the patient room. I can almost hear him say, It’s your funeral.

  Back in the room, José’s wrapping up blood work, and Cho’s whispering with Arora. He shoots a little sneer my way.

  But I won’t give him the satisfaction of a response.

  “We’ll be back this afternoon to check on you, okay?” I tell Alina.

  She nods.

  “And I might not be able to score you ice cream yet, but I can definitely get you some real strawberries tomorrow.”

  She grins. “Cool.”

  José tucks her in, and her dad waves ever so slightly at me as we walk out.

  Two down. Six to go.

  Nurse José gives me a thumbs-up and runs ahead. Cho does this weird, curt nod before we move on to the next.

  I can hear my aunt before I see her. She’s in the room two doors down, and shouting. As expected.

  Arora is already in there, and facing the wrath of Dragon Auntie.

  “I don’t want her on the case. Period.” Anya Auntie glares at us—well, at me—as we walk into the room. “She’s too young, too inexperienced, and too bold. I told you. Get her out.”

  The others are startled—and Cho looks positively gleeful. He can’t stop the grin from taking over his face.

  Arora is still hoping for reason to prevail. “Ms. Sharma, I understand. But as Dr. Sehgal bore witness when the incident occurred, it makes sense to have her present, at least for now, as we work toward a firm diagnosis. She is a doctor, after all.”

  My neck burns and I’m sure my cheeks are a livid red, but I don’t let my expression betray my humiliation.

  “A sixteen-year-old should not be a doctor!” Dragon Auntie shouts. “I don’t care what the state says.”

  How my cousin Pinky can sleep through all of this, I’ll never know. She’s slumped on the exam table, drool pooling, her chest rising with mild snores. I want to pick her up, cuddle her, and whisk her away from all of the pain she’s about to endure—her ranty, ridiculous mom the least of it.