Prologue #2
She hesitates. That hesitation is where my anxiety spikes yet again. I can tell from her expression that there’s a roadblock.
“The surgery is highly specialized. There are only a small number of cardiac surgeons in the country who perform it regularly. The closest one to us is at Penn Medicine in Philadelphia. We’d need to transfer Fabio’s care, coordinate pre-operative testing, schedule the surgery itself, and then plan for several months of cardiac rehabilitation afterward. ”
“Okay,” I say again, slower this time, because I can feel where this is going.
“I want to be straightforward with you about the financial picture. This is not a routine procedure at a local hospital. Between the surgeon’s fee, the facility costs, anesthesia, the ICU stay, the pre-op workup, and the cardiac rehab program, the billed charges could easily exceed two hundred thousand dollars.
Possibly more, depending on how the recovery goes. ”
Her terrifying number just hangs in the air between us. I made twenty-six thousand last year. Two hundred thousand dollars might as well be two hundred million.
“And from your expression, I’m guessing insurance won’t pay for all of that?” I ask with trepidation. My gut is telling me no. Hell, her face is telling me no.
“Insurance will cover a portion. How much depends on your brother’s plan. If Penn is out of network for him, even with insurance you could still be looking at tens of thousands of dollars out of pocket. I’ve seen cases where the gap is sixty to eighty thousand dollars or more.”
I nod because I don’t trust my voice. Sixty to eighty thousand dollars.
I have eleven hundred in my checking account at the moment.
I used to have a savings account, but I stopped putting money in when the transmission went out on my car.
My credit card has a four-thousand-dollar limit that is maxed out.
I’m fucked. I’m absolutely fucked. And if I’m fucked then Fabio is fucked too.
“There are financial assistance programs,” she says maybe because my face is showing my panic.
“The hospital has a social worker who can walk you through options. Payment plans, charity care applications, medical fundraising platforms. I’d encourage you to start that process as soon as possible, because the sooner we can get Fabio scheduled, the better. ”
“How soon does he need this?”
She pauses again, but it’s not for drama. I can tell she’s choosing her words carefully.
“I don’t want to alarm you, but I also don’t want to understate this.
The degree of obstruction we’re seeing is severe.
Every day he goes without the surgery, he’s at risk for another cardiac event.
The next one could be worse. I’d like to see him in the operating room within the next two to three months, ideally sooner. ”
Two to three months to find eighty thousand dollars.
Sure. No problem.
“How did no one notice this condition?” I ask breathlessly. How did I not notice?
She lifts one shoulder. “I know it feels impossible that something this serious could have been missed, but HOCM can be quiet. Unless someone was looking for it, unless he’d had the right kind of heart imaging, it most likely would have gone undetected.”
“I see. I… I can’t believe I had no idea he was so sick.”
“Please don’t blame yourself.” Her gaze softens as her professional mask slips. “There isn’t standard broad screening for asymptomatic people unless there’s a family clue, so someone without good medical care could easily slip through the cracks.”
“I have no idea if there’s a family history of this. And I can’t ask because both of our parents are gone, and we have no other family.”
“I’m sorry,” she says.
“Can I see him?” I croak.
“Yes, of course.” She gives me an empathetic look. “I’m sorry. I know this is a lot to take in.”
“Yeah.” I try to smile because she’s being kind. “But I appreciate all the info. At least now I know what I’m up against.”
She nods. “Absolutely. That’s half the battle.”
Unfortunately, the other half of the battle requires giant amounts of money that I don’t have.
She walks me to Fabio’s room and then leaves quickly. Fabio looks pale and frail. He’s in a bed and there are wires running from his chest to a monitor that beeps in a steady rhythm. He’s nineteen, but Fabio has always been small for his age. Is that because of his heart condition?
The heart condition I didn’t know he had.
The fact I had no idea something was seriously wrong with him floods me with guilt. He’s always been easily fatigued, but it never occurred to me it was because of his heart. My mom was slender and fragile, and I just thought he took after her.
He opens his eyes when I walk in and tries to smile. His black hair is messy and his blue eyes dark with worry. “Before you say anything,” he says, “I didn’t do anything stupid. I was literally just standing in the kitchen making ramen.”
“I wasn’t going to blame you.” I move to the bed and take his hand.
He grips my fingers tight and my eyes sting.
He looks terrified and my heart aches. I want so much to give him good news, but I’m still trying to swallow the grim information the doctor dumped on me.
I’m desperately trying to think of a way out of this nightmare, while not telegraphing my panic.
“I… I was just minding my own business, making ramen.” He laughs gruffly. “And then the floor was a lot closer to my face than it usually is. I tried calling you, but you didn’t answer. So I yelled for help, and by some miracle, Mrs. Padilla heard me. For once the thin walls came in handy.”
I bite my cheek to stop the wave of fear from escaping and spilling all over him. “Do you feel okay now?” I’m sure he’s on pain meds so he probably feels great. I could use some myself.
“Yeah, I feel okay right now,” he says softly.
I pull the chair up to his bed and sit down, still holding his hand. His fingers are cold. He’s always had cold hands, since he was a little kid. All my life I’ve held them between mine to warm them up. I do that now, cherishing the feel of my little brother’s hands in mine.
“They said something is wrong with my heart,” he says. “Like, a really bad thing. Not just a passing-out thing.”
“Yeah. It’s not a good thing.” I swallow hard. “But it’s fixable. There’s a surgery for your condition.”
Relief fills his eyes. “Are we talking, like, a big surgery?”
I nod. “Open heart.”
He doesn’t say anything for a minute. He just looks at the ceiling and I can see him processing everything. He’s always been like that. Even as a kid. When I told him Mom and Dad weren’t coming home, he didn’t scream or cry. He just went very quiet. The tears came much later in the night.
“Can we afford it?” he asks. “Open-heart surgery, that… that can’t be cheap.”
“Don’t worry about that,” I say firmly.
“Elio.”
“I said don’t worry about it. That’s my department. Your department is resting and not making ramen unsupervised anymore.”
He almost laughs. Almost. Then he squeezes my hand and says, “I’m sorry.”
“For what? For having a heart condition? That’s a weird thing to apologize for.”
“For being expensive,” he says quietly. “You’d be better off financially if you hadn’t had to take care of me all these years.”
“Shut up, Fabio,” I growl. “Don’t you ever say that again, do you hear me?” My anger washes over him and he nods, looking guilty.
“Sorry.”
“It’s okay, just, don’t say shit like that.” My eyes burn. “I’d be lost without you. You’re the best fucking thing in my life, okay? You’re not a burden. You’re my everything.” My voice breaks with emotion.
“I’m sorry. I shouldn’t have said that.” He squeezes my fingers. “I just know you’re already so stressed and now this has to happen?”
His words make my chest hurt. He’s such a good kid.
He never complains. He always just tries his best to make things easier on me.
He’s never grumbled that he has to wear secondhand clothes because we’re always broke.
He’s spent his entire life trying not to cause any problems because he knows how hard I work to keep us above water.
And now this happens and he thinks he needs to apologize for the crime of being sick.