41. Ava
FORTY-ONE
AVA
I sit on the edge of an exam table as Malia checks my vitals. My mind is still heavy with fog, but strangely, I feel lighter than I do after most episodes—embarrassed for causing a scene, but safer, I guess, having Knox here with me.
He rubs his chin from a chair beside me, a harried look on his face and his elbows braced on his knees. Our roles today have completely switched and it’s exhausting.
“Your vitals are fine, Ava. But you probably already know that, if this is a regular occurrence.”
I nod because she’s right. I’ve gone through this a dozen times before, and other than waking up with IVs in my arms during ambulance transport after passing out in public places, I am always “completely healthy” by the end of it.
“How often is ‘regular’?” Malia asks, taking a step back.
“A couple times a month while I had my prescription. I ran out a few days ago.”
Malia purses her lips. “And how long has that been going on?”
“Well—” I glance at Knox. “The short story is, I’ve had a version of these episodes my whole life, but the summer before I started high school, I was diagnosed with petite mal seizures and put on meds to regulate them.”
“And you saw a specialist who diagnosed you?”
I nod. “I went through a series of tests, and even though my results were inconclusive, they found ‘abnormal synapsis in my frontal lobe,’” I add with air quotes.
Malia takes a seat on the rolling stool and sets her clipboard aside. “And you’ve been on the same anti-epileptic drugs since and with the same doctor?” She’s casual and soft-spoken, and even if I’m currently her only patient, she’s attentive and curious, which puts me at ease. There is no side-eye with her. No judgment.
“I’ve been on a few different prescriptions over the years,” I explain. “I had adverse reactions to some of them—prescriptions, not doctors. Well—” I correct with a shrug. “I guess I’ve had some adverse reactions to my doctors, too, but that’s not what you’re asking.” I loathe the wobble in my voice. It’s borne of years of fear and anxious frustration. “I’ve been on Zarontin, Lamictal, and Topiramate, that I can remember off the top of my head, and I’ve seen three neurologists in the past six years because of my medical coverage.”
Malia stretches her legs in front of her, crossing her ankles. “And these episodes worsened in high school, you said?”
“More or less.”
She tucks a loose strand of hair behind her ear. “I know you’re out of your pills now, but before this week, do you think they’d been helping?”
Groaning, I run my hands over my face. Not because I’m exasperated with her, but because the more I talk about this out loud, the more I wonder what the hell I was doing all these years, forking out money for pills I couldn’t afford. “The pills didn’t stop them from happening,” I admit, “if that’s what you’re asking.”
Malia glances at Knox, but he’s staring at me and doesn’t notice. “One last question,” she says carefully, and I can tell I’m not going to like it. “This week aside, have you had significant trauma over the years that stands out to you?”
Instantly, my gaze shoots to Knox, too, lingering on him as I consider where the hell I should start and how much to say.
Malia glances between us and clears her throat. “Would you like to speak privately?”
“No—” I shake my head, snorting a nervous laugh. “It’s fine. Knox knows most of my trauma already.” I swallow thickly, but this time, I have a question for her . “Can I ask why you want to know? I’m sensing you’re about to drop a bomb on me that I should prepare myself for.”
Malia offers me a cautious smile. “Have any of your doctors ever mentioned vasovagal syncope?”
I frown, barely able to say the term in my head, so I would have remembered hearing it.
“The sensations you experience before you lose consciousness sound exactly like it. The vagus nerve is part of our fight-flight-freeze response system—specifically, the latter—and when it’s overstimulated, it can cause heart rate and blood pressure to drop so low that blood flow to the brain is reduced. It’s quite common, actually. Lightheadedness, feeling sweaty or clammy, tunnel vision, and the ringing in the ears you mentioned—they are all symptoms. Other people experience the same reaction when they have excessive bowel movements and food poisoning. Or when they faint at the sight of blood. And heat—heat and dehydration contribute to its severity as well.”
My frown deepens. It sounds so basic, which only makes me more confused by her questions. Especially when my doctors have never uttered those words to me before.
“Vasovagal syncope fainting spells can also be known as anxiety attacks—the body’s reaction to severe emotional distress and certain triggers,” Malia adds carefully, which gives me pause. There’s an unnerving certainty in her expression and resolution in her voice, and while I loathe thinking all my doctors have been wrong for so many years, something inside me deflates because I think Malia could be right.
“Why?” I ask, licking my lips. “Why don’t you think it’s epilepsy?”
“For starters, absence seizures are common in children, not in adults—children usually grow out of them. Add to that the list of neurology meds you’ve cycled through, your lack of convulsions, and the fact that seizures aren’t detectable, yet your spells have been. Epileptic attacks usually come out of nowhere. People can’t typically prepare for seizures, which is why some patients rely on animal companions to help alert them.”
Malia stares at me as I absorb the weight of everything she’s saying. As the dozens of appointments and bus rides and phone calls and bills—as the years of struggling with my brain health is reduced to anxiety.
“I always know when my spells are coming,” I say, reiterating out loud one of the biggest reasons I believe Malia is right. “I have seconds to worry about them...Sometimes minutes to grow more anxious as I try to stave them off.” I stare at her. “Which I assume is why it never works.”
“Perhaps. That’s why I asked about the trauma in your life,” Malia explains. “I’d like to know if you see a correlation with certain events over the past ten years that may have worsened your episodes.”
Acute frustration makes it difficult to speak as the pieces fall into place. “My mother died when I was young,” I confess, staring at the cement floor. “And ten years ago, my uncle—my guardian at the time—took someone’s life in a car accident and went to prison.” Even if that’s only the tip of the iceberg, the list in my head continues. I think about Mitch’s harassment and threats, Lars’s constant bullying, and how every day has been a struggle to keep my head above water, especially since Mavey got sick. And all of it—every extra shift I had to take to help pay our bills, every sleepless night and added worry only compounded it. And it all started ten years ago.
Knox’s gaze bores through me, and I squeeze my eyes shut. I can’t handle the guilt I’ll see on his face if I look at him because he unnecessarily shoulders part of the blame.
“I can’t imagine what you have been through, Ava.” Malia’s voice is kind. “And though I could be wrong, I don’t think I am. In fact, I think this is good news.” My eyes open and fix on her. Malia doesn’t look triumphant in the slightest. She seems happy for me. Hopeful. “Anxiety can be handled,” she continues. “It’s not easy, of course, especially now, but it can be reduced, and learning how to control your anxiety will help you in the long run.”
“I don’t get it.” Knox’s voice is loud compared to hers, startling me a little. He stares at Malia. “Why hasn’t she had one while we were fleeing wildfires or while she was trying to find help last night? Instead, it happens when she’s feeding the horses or making dinner. That makes no sense.”
“It may seem that way,” Malia explains, “but panic and anxiety are not the same. Ava isn’t having these attacks when she’s upset because, oftentimes, when we’re too busy holding ourselves together, it’s the quieter moments when it all catches up with us. Think of anxiety like bottled-up toxins. Once that bottle is full, it overflows or bursts.”
Malia’s eyes meet mine. “That’s why, if you can learn to manage your stress better, it will help. And the good thing about anxiety is there are many natural ways to cope and medicate yourself if needed. You won’t have to rely on a pharmacy to manage your health. Especially with the unpredictable state of things. You have the control, Ava. It’s not an easy path, but it is possible. The same can’t be said for seizures.”
“I have the control,” I repeat, shaking my head in disbelief. “I find that hard to believe, seeing as I’ve been trying to control this for as long as I can remember.”
“Yes, but until now you were taking anti-epileptics that changed the chemical balance of your mind. Once they are out of your system, we can focus on what will help you, not hinder you from getting better.”
I stare blankly at the wall, my grip on the exam table tightening.
“I am not saying that your doctors didn’t know what they were talking about because they did find some inconclusive results in your neurological scans. But,” she says crisply, “inconclusive to me means they never had a definitive diagnosis.”
“Which means you’re probably right,” I finish for her.
She purses her lips. “I believe I am. But for now, it’s all speculation. Our equipment is limited here, but I can run a blood panel to see if you have any vitamin deficiencies, and I’d like to check your hormone levels. The results will help us determine where to start. Only when your body is balanced will you be able to accurately gauge which approaches are working and which aren’t.”
“Yeah.” I nod, suddenly more exhausted. “Sure.”
“Perfect.” Malia grabs her clipboard. “I’ll be right back.”
“Thank you,” I blurt as she leaves the room. I’m sure she has better things to do with her time other than cater to me, and she’s not even getting paid for it.
Malia flashes me a quick smile. “You’re welcome, Ava.”
I inhale a lungful of much-needed air as her footsteps grow fainter, then make a pathetic brain explosion noise as I look at Knox. “That was...a lot.”
He walks over to me, the furrow in his brow deeper. “Yeah, it was.” His eyes shift over my face. “Are you okay?”
“I’m good. I’m just—over all of this.”
“I can imagine.” He shoves his hands in his pockets, assessing me. “You seem convinced she’s right, though.”
“It’s a hard pill to swallow, but I know she is,” I admit, and the words feel right. “Or maybe I just want her to be, because nothing I’ve done this far has worked.”
Knox huffs a sad little sound and rubs my arm. “Then, I hope she’s right, too.”
“Thanks.” I stare at Knox, admiring his hazel eyes even in the abhorrent overhead lighting. “And thanks for sitting with me. It’s really nice to have you in here with me.”
The corner of his mouth lifts, a dimple slightly forming in his cheek. “Thank you for letting me be here. I know this is hard for you.”
All Knox has wanted since all this started was for me to open up more. Now, he gets to be part of it, whether he wants to be or not. “Welcome to the craziness.”
Knox kisses my forehead. “I didn’t give you Loca by accident, remember?”
“Har har. Very funny.”
He smiles, and straightening, he glances around the room.
“I’ll be fine with her if you want to head out. I know you’ve been itching to check on the horses since you woke up. And now Tony is here.” I grin. Their reunion would have been picture worthy if I’d had my phone on me. “You should go. I’ll find you when I’m done here.”
Knox eyes me skeptically. “You’re sure?”
“Yeah, trust me. Malia is far less terrifying than Dr. Singh was. I think I can handle her.” I wink at him and gather my hair into a ponytail. “Now, go. Give the horses some love for me.”
“I’ll come back when I’m finished, if you haven’t found me yet.”
Despite his reluctance, Knox leaves me to my thoughts, and honestly, I’m happy for the breathing room. I lean back on the exam table with a sigh that feels like my first real breath in the last twenty minutes.
Mavey passed away, then Scott showed up.
Lars killed Scott, and I was stuck with Knox.
Knox took care of me when I thought he hated me.
Mitch showed up, and we formed an unspoken truce.
Knox diverted his trip to Kansas to drop me off in Sweetwater.
Julio died in my arms, and Knox was there for me again.
Now, we’re here when I thought last night would end far differently...
Mentally, I tick off the events of this week in my head, all of it a mix of dread and surprise. After what we’ve been through in the past few days alone, I know anxiety is something I can and need to manage better. I’m determined to.
I sit up, catching movement from the corner of my eye. The Hispanic girl I saw in the cafeteria this morning stands in the doorway fidgeting with something in her hand. She stares at me. I stare back.
Since she came into my doorway, I assume she has something to say, but as the seconds tick by, I cave first. “Hello.”
She tilts her head. “Hey.” Her mouth presses together in consternation as she looks me up and down without the slightest bit of reserve. “Are you with Knox?”
I grunt at her candor. Something tells me she’s not only asking if we’re traveling together. “Uh, yeah. I am.” My eyebrow lifts of its own accord. “Why do you ask?”
She shrugs, but I get the feeling she’s sizing me up. “Knox was in here this morning, too.”
I try not to smile. “He had a small accident yesterday,” I explain. I don’t know if she has a little crush on him or if she’s simply curious about me—or us, as newcomers—but she’s definitely giving me the once-over. “But he’s fine now.”
“I know.”
I blink at her, pressing my lips together to stop another smile, and glance down the hall for Malia. “So, what brings you to Exam Room One? Are you looking for someone?”
The girl turns what I think is an arrowhead over in her hand and leans against the doorframe. “Not really.”
“Just bored?”
She nods, but she looks more than bored. There’s something about the way her blue eyes shift to the obsidian—the way she fingers it like it’s the most precious thing she has—that resonates with me in a strange, unexpected way. She tucks a strand of loose, dark hair behind her ear and heaves out a sigh.
“I’m Ava, by the way.”
The girl lifts her head and shoves the arrowhead into her pocket. “Harper.”
“It’s nice to meet you, Harper. How long have you been here?”
She wanders into the room, running her finger over the metal shelf until she stops at the glass cabinet. “A few days.”
“Are you here with your family?”
I note the way her finger pauses on the glass before she drops her hand at her side. “No.” Harper’s mask of boredom and indifference slips as she turns, and her cheeks redden. Shit. The flash of what looks like hurt that’s there one second is gone the next, tugging at my heart. A hollow pit in my stomach immediately follows. This girl could have lost her entire family this week, and I so casually bring it up.
I clear my throat. “Are you from Texas, like me?”
Harper shakes her head and plops down in the chair Knox was sitting in. “My group home was in New Mexico. We came here when they evacuated Santa Fe.”
My heart sinks deeper. It should be a relief Harper hasn’t been alone through all this, but for some reason, it isn’t.
“Are you going to be okay?” she asks, and this time there is concern in her eyes as she stares at me.
“Ah.” I nod with understanding. “You saw my little fainting spell out there, did you?”
Harper blinks at me.
“Yeah, I’ll be fine. Thank you for asking. Sorry if I scared you.”
She shrugs again, and the tips of her shoes brush the floor as she leans back in the chair. “Is Lucy yours?” Harper folds her hands in her lap.
“No, she is Knox’s dog.” I smile. “She’s a sweet girl, isn’t she?”
Harper nods, glancing around the room. “I like dogs, but they never let us have them in the group home. I had one when I was a kid, though.”
“When you were a kid, huh?” I grin. “And what was his name?”
“Freckles. He was a Dalmatian. But he ran away when I moved in with my grandma. It sucked.”
“I bet it did. I’m sorry you lost your friend.”
Harper stares up at the ceiling, drumming her fingers on the arms of the chair. “I asked Jenny if we could at least get a rabbit or a hamster or something, but she said they stink, and her boss wouldn’t let her anyway.”
“So, I take it you like animals, then?”
With a head bob , Harper lifts her head and looks at me. “I’m going to be a veterinarian.”
I can’t help my smile as I imagine her no-nonsense bedside manner delivering any sort of news to her patient’s owner. “That’s a big job, and a good one. You must like animals a lot.”
“I pretty much love them,” she confesses.
“Well,” I say with a shrug, “maybe Knox will introduce you to his horses while we’re here.”
Harper’s eyes widen to saucers. “He brought horses ?”
“Two, in fact.” I can tell Harper’s mind is spinning a mile a minute. “He had a ranch in Texas.”
“I’ve never been to a ranch before. Did he have other animals?”
“Cattle. Pigs. I think that was it. We’re headed to his uncle’s farm next.” I pause. “At least, we were.” I realize I’m not certain what the plan is now, if we’re still going to Ransom, or when. All the questions that have plagued me since we started this journey return and settle in my shoulders, tightening the back of my neck again.
“What sort of animals does his uncle have?”
I force the deluge of uncertainties away for now, refocusing on her. “Uh, I—I’m not sure, actually. I’ve never been there.”
Harper screws her mouth up and drums her fingers on the chair again, thoughtful. “Do you really think Knox will let me see his horses?”
“I do. I’ll ask him when I see him again, okay?”
“Harper,” Malia says with a hint of exasperation. She steps into the room with a tray of empty vials and a lifted eyebrow. “You’re not supposed to be in here. You know that.”
“We were just talking.”
Malia gives her a sympathetic smile. “You know the rules.”
With a huff, Harper pushes herself up out of the chair. “Fine.” Sparing a last glance at me, Harper trudges down the hallway.
“Cute kid,” I mutter, though I’m not sure if cute is exactly the right word.
Malia shakes her head with a small chuckle. “Yeah, she’s cute and very curious. She speaks her mind too.”
Harper drags her feet as she disappears around the corner.
“Jenny,” Malia continues, “the social worker who brought the children in on Tuesday, mentioned Harper’s mother was a founding member in one of the major Moonie militias they busted up six years ago after the researcher kidnappings in Las Vegas. Harper has been moving around from different homes and facilities since she was three. I can’t figure out if she’s restless being cooped up here—yet another new place—or if it’s just another week for her.”
A lump lodges in my throat. No family in a world as crazy as this? I can only imagine how alone Harper must feel. “That’s really...”
“Horrible. Sad. Enraging,” Malia finishes for me. She grabs a cotton ball and tape from one of the drawers in the cupboard. “I know. And yet, a part of me wonders if somehow those kids are better off than the rest of us.”
I meet Malia’s gaze.
She shakes her head, almost thoughtful. “Most people have lost lifetimes of friendships and loved ones in the last few weeks alone. But for kids like Harper, this cruel life is all they’ve known, and I can’t help but think if, in a way, it has better prepared them for whatever comes next. Unlike the rest of us.”
Whatever comes next. I stare down the empty hallway as Malia pushes up my sleeve. A little part of me concedes she might be right and wonders if Harper isn’t a version of me lost in a spiraling world she’s simply trying to exist in. I pray that, whatever does happen next, the little girl will be okay.