Chapter Five
“LUCKY FOR US, it’s a straightforward diagnosis.”
Doctor Tremblay breaks the news with a smile.
We’re seated inside a room that looks more like how I pictured hospitals.
A curtain has been pulled across the middle to give the illusion of privacy on one side.
April is wearing a loose gown and sitting on a metal bed.
She’s attached to an IV tube, but otherwise looks like herself and the doctor says not to worry.
The IV is to rehydrate her; she’ll come off it in a couple hours.
A steady hum emanates from the IV, like a beehive.
Odds are, that’s the sound of electricity.
It’s surreal to know that somewhere, there’s a solar cell or turbine that April is hooked up to, pumping her body back to life.
She has colour in her cheeks and a grin on her face.
After all the agony of getting here, it’s worth it.
One look at her, and it’s clearly worth it.
“I gave her an emergency dose of insulin when she came in and she’s responded well.
Given that, I feel confident making a diagnosis,” says Doctor Tremblay.
“We’re still running tests to confirm, but I don’t foresee any complications.
Sadly, procedures that used to be simple take time now.
We’re waiting for the liquid from her urine sample to evaporate. ”
“Urine sample?” I repeat.
“They made me pee in a cup when I came in. Said there might be sugar in it.” April’s face puckers up, like she wants to laugh.
“I’m sorry… what?”
“Sugar crystals can form in the urine of those with untreated diabetes. It’s not the best verification method, but one of the few we still have,” says the doctor.
He keeps making these apologetic statements, clearly aware of what medicine used to be before the Quake, but from my perspective, he’s a magician. April was dying, and now she’s not. It’s that simple.
“But the medicine is working? The… what did you call it?”
“Insulin. Yes, it is.”
“Great. So she’s better? We can go?” I still need to pay them, but hopefully my mother’s earrings will cover that, and we can get off this damn island. If we can, I will scream, dance, throw myself into the ocean and swim across the Salish Sea.
The doctor’s welcoming smile fades, as if I’ve said something pitifully stupid. “I would like to keep her for observation tonight.”
“Good. Sure, let’s do that.” I can wait one night. I’ll crash at Sid’s place and sleep with the largest stick I can find tucked under my pillow.
“But that isn’t the heart of the matter, Ms. Hollins. Your sister’s condition is treatable, but persistent. I assume you’ve never heard of type 1 diabetes before?”
“I haven’t heard of any type of diabetes.”
“Then we need to have a talk.”
The doctor pulls out a diagram of the human body that’s far more sophisticated than any April and I have found in abandoned picture books.
Once or twice, I’ve come across an old medical textbook while scavenging, but they were always too heavy to take with us.
With a nasty lurch, I realize my understanding of the human body is no better than a child’s.
He points to a small spot on the torso that I’ve never seen labelled before called the pancreas.
Apparently, there’s a substance it secretes, which tells the body how to handle the energy we get from food.
Insulin. The word pops up again and again.
It’s essential for living a normal, healthy life and for whatever reason—environment, genetics, who knows—April’s body attacked her pancreas and now it has fully crapped out on her.
She can’t make insulin on her own. The only reason Doctor Tremblay was able to save her was because even without pre-Quake medicine, it’s still possible to get insulin by boiling down pig pancreases.
A shit load of pig pancreases.
“She’ll need regular injections for the rest of her life.
You’re in luck, though. Our hog population is high enough that we can process enough insulin to sustain up to thirty patients, and there are currently only nineteen other insulin replacement-dependent people living in the Gulf Island Nations.
Your sister can lead a long, healthy life. ”
“So… If she needs it for the rest of her life, then how much insulin do we need to take with us?”
His eyes crinkle with another mournful, pitying smile. “Ms. Hollins, insulin isn’t shelf stable. It lasts a month before it spoils. This hospital is one of the few places that spends the resources to maintain consistent refrigeration. She’ll need to live on Salt Spring.”
I feel myself nod, as if this is no big deal, but I can’t unstick words from my throat.
Back when we lit the fire, I knew there was a chance we could get trapped here.
Maybe this place would expect indentured servitude in exchange for medical care.
But I always held onto a glimmering hope that at some point, we could break out. But refrigeration?
I hadn’t realized there might be parts of living that were inescapable.
“It’s okay, Kayla. I wouldn’t want to live somewhere without a doctor again, anyway. I mean, it’s more than just the insulin, right? What if something else goes wrong?” says April.
“It’s true. You’ll need to manage your condition carefully to avoid long-term complications.” The doctor turns back to April and it hits me what a useless, selfish bitch I’m being, panicking right now. This isn’t even happening to me.
They must have talked this out already, because nothing he says surprises her.
It’s more like they’re picking up the thread of an old conversation.
She’s stoic as he tells her how to watch out for issues with her eyes or lightness in her limbs.
Monitoring symptoms matters so much now because it’s too difficult to regularly test blood.
She takes it all in, then asks if this will be written up for her, so she can read over it. I don’t absorb Doctor Tremblay’s answer.
She has to stay here. Anything else is a death sentence.
When I find my voice, they’re talking about dose size and frequency, but I’m too agitated to listen. “So what’s this going to cost us, long term?”
“Well, that depends,” says Doctor Tremblay.
“On what?”
“How quickly you obtain citizenship. Did someone have you fill out sanctuary papers?”
“Sure, sure.” And there’s already a demerit on them.
“Good, that’s the first step. Full citizens of our nation have a right to free healthcare. Until you qualify, you can expect to pay about a thousand dollars a year out of pocket,” he says.
“Okay.” I have no idea how much money that is.
Nothing in books from the pre-Quake days is particularly helpful in explaining how money works now.
It’s easy to find copies of popular ancient books, like Pride and Prejudice, where the characters lose their shit over someone having ten thousand pounds a year.
It’s also easy to find sailing magazines where a single yacht sells for a million dollars.
Nowadays, most colonies don’t bother with money.
Turned out to be nothing but useless paper when society collapsed.
But society has reared its ugly head on Salt Spring, so maybe it’s necessary here. It’s probably easier than maintaining a running tally of the going rate of pig pancreases versus the cost of a new axe or whatever else someone might want.
“We subsidize it as much as we can,” the doctor says, reading the dread on my face. “And there is another option, if you’re willing to explore it.”
“We’ll do anything,” I say.
“Well… your sister is only fifteen. Sanctuary laws are different for children.” He’s no longer meeting my eye; something horrible must be coming. “If you surrender custody of her to the state, she’ll be eligible for free care.”
“No fucking way.” I push back my chair.
“Kayla, I need the medicine,” April says. I almost kick her for even acting like this is an option. Does she have so little faith in me?
“I know. You’re going to have it and I’m going to get it for you. I’m not letting them take you away. We’re a family. These assholes aren’t taking that from us.”
“I understand your feelings completely,” Doctor Tremblay says. Liar. “I’m sure you’ll figure something out.”
“I will.”
If only I had a single clue how.