Chapter Twenty-Eight
Palisades, New York
2023
Back in her own kitchen, Ruth finds that she cannot move beyond the counter, the scene of the crime, the inception of her nightmare. Her bottom is glued to the same stool where she’d been sitting when that stupid antique phone rang. Ruth weighs ten thousand pounds, and her bones are toothpicks inside the burden of her skin. One really bad phone call can waken and set loose the sleeping demons of the soul. Ruth knows this, has always known it. And yet that knowledge offers nothing in the way of assistance. In her lifetime of collected griefs, there has never been a moment worse than this one. Her dead or living daughter is sixteen hundred miles away, and she is stuck here. On this stool.
She calls the boys and then her father, commits the domestic atrocity of relaying the news. She surprises herself with the strength of her voice, the composure of her tone. She does not know that this is a direct maternal inheritance. Carlos, who’s in Manhattan at rehearsal, she instructs to get an Uber home immediately. Vic, who found a good job at a Boston architectural firm after college and is still at his desk working late, she asks to book a flight directly to San Juan and meet them there as soon as the weather clears, as soon as he can. She stops herself from adding “just in case.” Ruth is almost relieved when her dad doesn’t answer, and she can type the worst of it into a text message instead. Daisy was in an accident. Call me back.
When the calls are finished, Ruth tortures herself by remembering every horrible thing she’s ever said to Daisy. She replays every inane argument, every regrettable utterance. When they’d finally gotten their COVID vaccines and the world had reopened, when, instead of finally going to college, Daisy had announced that she was going back to Puerto Rico, their already heated, tenuous relationship hit a new low. Some months later, when Daisy confessed that she was starting a business, opening a store down there, Ruth feared her daughter would never come back, that they would never recover from this folly.
Now Daisy’s store has been open for over a year, and by all accounts (both anecdotal and financial) it is thriving. Still, Ruth is the only member of the family who hasn’t been to see it. Even Vic, who’s always been the outlier, whose independence takes him farther from his family all the time, even he went to San Juan for a long weekend in December, to see Daisy’s shop and support his baby sister. Ruth alone has been too stubborn in her disappointment, too judgmental, too exacting. She has refused to accept that Daisy has the right to forge a nontraditional path, and that path might be legitimate. Admirable, even.
Ruth drops her elbows onto the counter and lowers her forehead onto the knot of her folded hands. She knows with sudden clarity that this is her fault, all of it. Daisy’s accident, the very fact of her daughter being in Puerto Rico to begin with. Maybe this is partly why Vic is so distant too. Carlos will follow, she thinks. He will flee as soon as he’s able. Her children are leaving, and not just in the growing-up way. Because there’s so much Ruth has refused to share with them, because she has kept this door sealed against them, Daisy went looking for the key herself. That is why they are here, at this terrible moment.
There are so many conversations Ruth needs to have with her kids. So many buried things she now wants to unearth.
“Please God,” she says out loud. “Don’t let it be too late.”
Ruth does not exactly sleep, but she leans back on the couch momentarily, performing the kind of restful absence from her body that’s only possible in times of grief or catastrophe. She closes her eyes, and the obliterating blackness flows into her mind like merciful ink. She stays like that for some number of minutes, and when she opens her eyes again, she is filled with a determination to make good use of the wicked, cavernous stretch of hours ahead.
She gathers her wallet, her insurance card, her laptop, and her glasses before calling the insurance company and following the prompts. It takes her seventeen and a half minutes to get a live human being on the phone. The live human being’s name is Yvette, whose first order of business is to inform Ruth that their conversation is being recorded for training purposes and to ensure customer satisfaction. But as the customer in question, Ruth feels already unsatisfied because her daughter may or may not be still alive, and it took Yvette seventeen and a half minutes to answer her call. Ruth doesn’t know where to begin.
“Member ID number?” Yvette suggests.
Ruth recites the number.
“Can you verify your name and date of birth, please?”
“Mine or the patient’s?”
“Oh, you’re not the patient?”
“No, the patient is my daughter.”
“Okay,” Yvette says. “So then your daughter’s name and date of birth.”
“Daisy Hayes. April 17, 2001.”
Ruth can hear typing, which stops abruptly.
“Oh,” Yvette says. “Your daughter is not a minor?”
“No,” Ruth says. “She’s twenty-two.”
“I see.”
More typing.
“I just need to check with my supervisor,” Yvette says. “I’m not sure I’m permitted to discuss her care with you.”
“She’s my daughter,” Ruth says impotently.
“I understand that, Ms. Hayes, I’m sorry. But there are HIPAA laws in place to protect the privacy of all our patients. Typically we can only discuss a patient’s care directly with the patient herself. Is your daughter available?”
Ruth closes her eyes and breathes as slowly as she can.
“No,” she says. “My daughter is not available.”
“Just hold on one second,” Yvette says, and then before Ruth can respond, there’s a click, and a dreadful swarm of smooth jazz that interrupts itself every twenty seconds to reassure Ruth that her call is very important. After six minutes, the smooth jazz expires, Yvette returns, and Ruth makes the sign of the cross.
“Okay, good news!” Yvette says chirpily. “My supervisor says it’s fine to discuss certain elements of your child’s care because there’s a previous note on Daisy’s file indicating you as her emergency contact.”
“Okay, great,” Ruth says, and then she tries to tackle the absurd reality that she is now twenty-five minutes deep into this phone call and has not yet managed to tell Yvette that her daughter is in an emergency room in Puerto Rico, and that she may or may not, in fact, still be in a condition to require medical insurance at all.
“So what can I help you with today?” Yvette asks.
Ruth tries to stand back from the question and assess it much the way a mountain climber might plan the best route to the summit.
“My daughter was in a serious accident,” Ruth begins.
“Oh, I’m so sorry,” Yvette says.
“She was walking, I guess. And she was hit by a car.”
“Oh gosh.”
Yvette’s responses fall like obstacles into Ruth’s path, and Ruth wishes Yvette would stop interjecting so she can get these awful words out. She cannot abide the interruptions.
“I received a call this evening that she’s, Daisy, she’s in the hospital. And they said there was some kind of problem with her insurance. They said I should call just to verify her coverage.”
“Oh my gosh,” Yvette says again, “I’m so sorry.”
“Right. Thank you.”
“Let me see what I can figure out here,” Yvette says, typing. “Let’s just see what we have going on here.”
In the machine-quiet that follows, while Yvette types, Ruth begins to shudder, from her core and up through her collar bones and out to the tips of her fingers, which, she realizes now, are freezing. The tip of Ruth’s nose is also freezing. She knows it’s not cold out. She touches the speakerphone icon and sets her phone on the arm of the couch so she can tuck her cold hands into her armpits. After a few moments, the shivering subsides.
“Oh. This is…” Yvette doesn’t finish her sentence at first. She types a little bit more. “This is from Río Piedras Trauma Hospital in San Juan?”
“That’s right.” Ruth begins to shudder again, but she breathes through it this time.
“Right, I see the note here, that they called,” Yvette says. “Where is that, the Dominican Republic?”
Ruth blinks. “Puerto Rico.”
“Okay.”
Ruth can hear Yvette sucking air through her teeth.
“But still, out of the country,” Yvette says.
“Well, not really,” Ruth says. “Not technically.”
Yvette is silenced by this. Ruth reads the silence as quizzical.
“You said Puerto Rico?” Yvette finally manages.
“Yep,” Ruth says. “Which is technically a United States territory.”
She does not say colony because she’s in enough trouble with Yvette already. Yvette does not immediately respond.
“It shouldn’t be any different than if she went to an emergency room in Connecticut,” Ruth says, somewhat desperately.
“Well,” Yvette says, and Ruth can read every measure of the woman’s significant reluctance in that single, stretched syllable. “I… it looks like, right, I do see that we have a couple of in-network providers in Puerto Rico. But unfortunately, the Trauma Hospital is out of network.”
Ruth hears these words, but they make no impact.
“Okay,” she says. “What does that mean?”
“It means her medical care at that particular hospital is out of network.”
Now the words begin to make light, sporadic contact, like raindrops on dry pavement.
“But it was an emergency,” Ruth says with utter futility.
“Yeah,” Yvette says, with matching futility.
“So. What are we supposed to do?”
Ruth does not yet know the extent of Daisy’s injuries. She knows that Daisy is sufficiently injured that she could not call home herself to announce her injuries. She knows that Daisy is, at best, unconscious. At best, when she is stable enough, Ruth hopes they will move her to the intensive care unit. Ruth’s faculties regarding Daisy’s medical care have thus far been engaged in the direction of praying that her daughter does not die. Her only wish is for Daisy’s survival. There is literally no part of her brain that can care, at this moment, about the financial cost of that survival. What are we supposed to do?
Yvette does not have an answer.
“Okay.” Ruth has to try. “Okay, so what is our out-of-pocket limit?”
“It is…” Yvette seems relieved to be typing again, to be retrieving the answers to simpler questions. “Eight thousand seven hundred dollars for Daisy individually. Nineteen thousand three hundred eighty dollars for the family.”
That is a large number. Ruth does not care. She will sell her car. Whatever. She will empty Daisy’s college fund.
“Okay,” she says.
“But that’s for in-network care.”
Ruth shakes her head. “So?”
Yvette makes her finish the question.
“So then what’s the out-of-pocket limit for out-of-network care?”
Yvette hesitates for a moment. “There isn’t one.”
This time it lands, the information really, really lands. It is a cataclysm. A meteor striking the Earth. Ruth begins to shudder again.
“Can she move to an in-network hospital?” Yvette asks then.
The shuddering stops, and as soon as it’s passed, Ruth notes the appearance of an enormous, thundering headache in its wake.
“I don’t,” she says. “She’s.”
Yvette is typing.
“She’s in a coma,” Ruth says, not knowing whether this is strictly, medically accurate, but needing to impart the gravity of Daisy’s condition to Yvette, needing her to understand the absurdity of the suggestion that maybe Daisy should get herself into a cab and head on over to an in-network hospital.
“It looks like there’s one…” Yvette says. “Oh.”
“Where?” Ruth asks.
“In Saint Thomas.”
“Saint Thomas,” Ruth repeats, wondering if Yvette will hear the insanity of it.
“Yes,” Yvette says.
“The island,” Ruth says. “Of Saint Thomas.”
“I think so, yes,” Yvette says. “It’s actually not that far. It’s within the hundred-mile radius.”
“So, to be clear, you’re telling me there is no in-network hospital in the United States territory of Puerto Rico?”
“Correct.”
“And my daughter should go instead to the in-network hospital on the separate island of Saint Thomas, which is less than a hundred miles away. In the US Virgin Islands.”
“Well,” Yvette says. “I mean, obviously that’s not a great option.”
“No,” Ruth says, but then she remembers something else Yvette said, and she throws her mind back to that detail with unreasonable hope. “But you said there were a couple of in-network providers?”
“Yes.” A pause while Yvette retrieves the appropriate information. “There’s a dermatologist in Carolina.” Another pause. “And looks like an endocrinologist in Ponce.”
They are both quiet for a moment while they consider this additional information.
“And a hospital on Saint Thomas,” Ruth says quietly.
“Not very helpful, I guess,” Yvette acknowledges.
And then, like a maniac, Ruth begins to laugh. It goes on for some moments, until the shuddering returns to displace it. Yvette clears her throat.
“So.” Ruth gathers what feels like every remaining bit of strength in her body and she funnels it through the mess of her brain, and then out of her mouth in the form of words. “Please stop me if I have any of this wrong, but I think what you’re saying is that, despite the fact that I pay more than thirty thousand dollars a year so that my children will have health insurance, and despite our exorbitant copays and deductibles, and despite the fact that I have never missed a payment, never been late on a payment, and despite the fact that Puerto Rico is a US territory, you’re saying now that my comatose daughter is basically uninsured in Puerto Rico.”
If there was any part of Yvette that had started to soften to Ruth, this is the moment that stops all that.
“Your daughter is still insured,” Yvette says. “She’s just currently out of network.”
“You won’t pay for her care, is what you’re saying.”
“We will pay for her care at any in-network facility,” Yvette says.
“But there are none in Puerto Rico,” Ruth says. “So she’s not covered.”
“She’s out of network.” Yvette repeats it now like it’s a mantra, like it will save her from eternal damnation. “I’ll be happy to send you a list of our in-network facilities if that would be helpful.”
“That would not be helpful.”
Ruth tips her head back on the cushion behind her, and feels the pain spread like a band behind her eyes and across her scalp. The silence becomes uncomfortably long, and then Yvette is the one to break it. She reverts to her script because what else is she going to do?
“Is there anything else I can help you with this evening?”
In this moment, Ruth’s rage manhandles her feeble humanity.
“Yes, just one more thing, Yvette,” she says. “You can go fuck yourself.”
When Carlos arrives, he shows Ruth a hurricane app on his phone, and a churning spiral fills the screen.
“What is that?” she asks.
They are standing at the foot of her bed, in front of her half-filled suitcase.
“Real-time satellite imagery.” Her son turns the screen so she can see it more clearly.
She squints, but can’t make sense of what she’s looking at. “Where is Puerto Rico?”
Carlos pinches the screen, zooms out so she can get her bearings on the map. There is Cuba. There is Hispaniola. Where is Puerto Rico?
“I don’t see it,” she confesses.
Carlos zooms in again. “It’s under there.”
But there’s nothing to see. No visible land beneath the twisting roil of the behemoth storm.
“Oh my God,” she whispers.
“It’s bad, Mom.”
Mama is at the kitchen door, and Carlos gets up to let her in.
“Did you pack?” she says to Ruth, who’s back in the kitchen putting water in the kettle.
“I started, Mama.”
“We can’t go anywhere yet anyway, Grandma.” Carlos shows her the app, but his grandmother waves it away.
“There have always been storms,” she says.
“But like this, Grandma?”
“You have no idea,” she says. “There were frightful hurricanes, truly. I think the only difference was, we didn’t have a twenty-four-hour news cycle, no cell signals to go dark. The world wasn’t watching—so when we got annihilated, we got annihilated. We were on our own!”
“Some things don’t change, I guess,” Carlos says.
“Anyway, I know how this works, okay?” she says. “I remember this much: you just have to hold on.”
Ruth remembers too. Only one major storm that she can recall with any clarity from her own childhood. She must have been five years old or so, the year before they moved. But then dozens of storms since, waiting down a fragile phone line for word of Papamío, Mamamía, Lola, Benny. In fact, they all know how this works, at least from afar: it will be some ghastly, yawning chasm of hours. The trick is only to endure them. Those hours will march by at a deadening pace, but march by they will. They should play Uno or Monopoly. They should eat junk food and tell stories. They should sleep when they can, but without leaving one another’s sides, without bothering to brush their teeth or change into their pajamas or slide their exhausted bodies between the sheets of a bed, because therein lie nightmares. But if they hold on to one another very tightly and fill the waiting hours with color and warmth and light, then eventually, eventually the storm will lift, it will. And that is where hope lives, in the quiet hours after Puerto Rico is left behind. There will gradually emerge, during those lurching hours, some clarified picture of destruction. It will be catastrophic or manageable. Whoever is left will roll up their sleeves as they have always done and begin the work of recovery. And in that bright yellow time, there will be birdsong. The phone will ring. And Daisy will be there, she will be there. She must.
Ruth presses her eyes closed as she wills herself to the other end of this coming press of hours.
“So, I made some phone calls,” Mama says. “And I got us a flight.”
Ruth opens her eyes again, and she and Carlos both turn to look at Mama. “What?” they say at the same time.
And then Carlos adds, “That’s impossible, Grandma. There are literally no flights.”
“It’s not a commercial flight.”
“But how, what—” Ruth cannot formulate the appropriate question.
“I called your father—”
“Dad?” Ruth’s confusion consumes her whole face. “He didn’t answer when I tried—”
“Not your father.” Mama shakes her head, slaps a palm against her temple. “Not your father, what am I saying? I called my friend, you remember my friend Candido?”
Ruth is puzzled. “The boy you grew up with? The housekeeper’s son?”
Now Mama frowns, baring her bottom row of teeth, and Ruth experiences a familiar flare of worry about her mother’s cognitive function, her slipups, her confusion, but for all that, she seems to have gotten better recently. And anyway, Ruth has no space for that fear right now. It bounces, but doesn’t stick.
“My friend, yes,” Mama confirms. “Well, the housekeeper’s son , as you call him, now happens to own the largest freight company in Puerto Rico.”
“Holy shit, Grandma!” Carlos says.
“He has already mobilized a plane for us in New Jersey,” Mama says, “and he assures me we will be the first flight to land when the airport in San Juan reopens.”
“Baller,” Carlos says.
Mama cocks her hip at him.
Ruth is already back at her son’s shoulder. “Open that hurricane app again. Can you tell what time it’ll be past, or mostly past?”
Carlos clicks and scrolls. “It’s impossible to say exactly, but they’re estimating most of the rain will stop by midafternoon tomorrow.”
Ruth looks at her mother. “So depending on the damage, the airport could reopen by what, tomorrow evening? We could be in the air by late tomorrow.”
“We could be with Daisy by tomorrow night,” Carlos says.
“It’s possible.” Mama nods.
Now they’re all thinking the same reverent thought. They’re already in the prayerful quiet of that distant room. Whatever will happen next will happen there. They will face it together.
“We’ll be ready,” Ruth says.