Viral

Chapter 1 August 15

Okay, you guys! It’s four-thirty and time to get this barbecue show on the road,” Brian Yves Murphy ordered, clapping his hands to get his family’s attention. His wife, Emma, and his daughter, Juliette, were draped over the living room furniture in the modest two-bedroom cottage they had rented for two weeks across from a hardscrabble beach in Wellfleet, Massachusetts, just beyond the town’s harbor. All of them were appropriately exhausted after an active, fun-filled midsummer day that marked the beginning of their final week of vacation. Because of the SARS-CoV-2 pandemic, they’d opted for a road trip vacation rather than flying down to Florida to use Emma’s parents’ empty condo, as was their usual summer getaway.

“Can’t we just recover for ten to fifteen minutes?” Emma pleaded jokingly despite knowing full well that Brian wouldn’t hear of it. In truth, she was as compulsive as he in terms of getting the most out of every minute of their vacation while the weather held. On top of that, she was also as compulsively fit and active as he. That morning she had awakened just after dawn and had soundlessly slipped out of the house for a bike ride and to be first in line at PB Boulangerie for their one-of-a-kind, freshly baked almond croissants. It had been a welcome surprise when they discovered the French bakery so far from what they called civilization. As lifelong residents of Inwood, Manhattan, they considered themselves quintessential New Yorkers and assumed anything outside of the city was hinterland.

“Sorry, but no rest for the weary,” he said. “I’d like to get to the Newcomb Hollow Beach parking lot before the evening rush to make sure we get a spot.” They had found over their first few days that Newcomb Hollow was their favorite Atlantic-side beach, with fewer people and high dunes that acted as partial windbreaks from the onshore breeze.

“But why the rush?” questioned Emma. “We already got a beach parking permit when we got the fire permit.”

“The parking permit lets us park, but it doesn’t guarantee a spot. Plus, Newcomb Hollow Beach is a popular spot for obvious reasons.”

“Okay,” she said agreeably. She got up and stretched her shoulders, which were mildly sore from the kayaking on Long Pond they had done that morning, an unusual workout for both of them. Then in the early afternoon she and Brian had done their daily mini-triathlon that involved biking ten miles to Truro and back, swimming for one mile in the bay, and running for five more into the Cape Cod National Seashore. Meanwhile, four-year-old Juliette had spent time with a local high school girl named Becky whom they had luckily found to serve as a daily sitter on day one. The lucky part was that Becky, despite being a teenager, was surprisingly acceptive and attentive to the required testing, mask wearing, and social distancing mandated by the Covid-19 pandemic.

“I’ll get towels, the grill, briquettes, beach chairs, and toys and load it all in the car,” he rattled off, heading into the kitchen. He’d been looking forward to the barbecue for several days. Although they wouldn’t have the sunset like they did every evening over Cape Cod Bay, the Atlantic side was glorious, especially compared to the narrow, seashell-littered beach in front of their cottage.

“Ten four,” Emma said. She glanced down at Juliette. The child seemed to already be asleep, although Emma was aware she could be pretending, as she often did when she didn’t want to be bothered. With her eyes closed and lips slightly parted, she was clutching her favorite toy and constant companion named Bunny: a foot-long, very floppy, light brown, worse-for-wear stuffed rabbit with one missing eye. Emma couldn’t help but stare at her with loving eyes, thinking as a mother that Juliette might very well be the world’s most beautiful child, with her slightly upturned sculpted nose, Cupid’s bow lips, and thick blond hair.

Initially both she and Brian had been taken aback by their daughter’s hair as it grew in. The expectation had been that it would either be Emma’s flaming red or Brian’s blue-black. Instead it had come in as blond as golden corn, establishing from the outset that Juliette was her own person. The same thing happened with her eye coloration. She ended up green-eyed in contrast to Emma’s hazel and Brian’s blue. But there were some definite commonalities. All three Murphys had pale, almost translucent, Irish skin that required constant application of sunscreen to keep from getting burned. Also similar were their well-muscled and long-limbed figures. Even at age four, Juliette promised to be as athletic and tall as both her father and mother, who stood at six-one and five-eight, respectively.

“Hey! What are you doing?” he questioned as he wheeled a small portable kettle charcoal grill through the living room. He’d caught her hovering over Juliette. “Chop chop! What’s holding up the show?”

“I was just momentarily overwhelmed by our daughter,” Emma confessed. “We are so lucky she’s healthy and so damn cute. In fact, I think she might be the most beautiful child in the world.”

Brian nodded but rolled his eyes playfully. “Sounds like a serious case of parental bias. There’s no doubt we’re lucky, but let’s please hold up on our appreciation until we’ve parked and are on the beach.”

She threw the Speedo swim cap she was holding at Brian, who laughed and easily ducked away before pushing out into the front yard, letting the screen door bang behind him. The characteristic noise reminded Emma of the summers she’d spent as a child out on Long Island. Her father, Ryan O’Brien, had done very well for himself and his family after starting a successful plumbing company in Inwood. Emma and Brian had both grown up among Inwood’s sizable Irish community and had actually been aware of each other as grammar school — aged children while attending PS 98 even though he was two grades ahead of her.

For her part in preparation for the barbecue, she went into the kitchen, got out the cooler, and after putting in the cold packs from the freezer, filled it with the hamburger patties she’d made the previous day, the fresh de-gritted clams they had gotten earlier that morning at the harbor, a bottle of prosecco, and some fruit juice for Juliette. The unhusked summer corn was in a separate shopping bag, as were the mille-feuille from the bakery.

A half hour later the family was in their Outback Subaru, heading east toward the Cape Cod National Seashore preserve. Juliette was buckled into her car seat next to the cooler, an inflatable boogie board, and three folded beach chairs. As per usual Juliette was holding on to Bunny while watching a cartoon on a screen built into the driver’s-side headrest. At Juliette’s feet were the rest of the beach toys, including pails, sand molds, shovels, and a pair of Kadima paddles.

After crossing Route 6, both Brian and Emma eyed the Wellfleet Police Department as it came into view. The building was a quaint, gable-roofed white clapboard structure with dormers that looked more like a country inn than a police department.

“I can’t help but wonder what it would be like being a police officer way out here in the middle of nowhere,” she observed. She turned to get a final glimpse of the picturesque building with a split log fence defining a visitor’s parking area. There was not a squad car in sight.

“It is hard to imagine,” he said with an agreeing nod. He’d had the same thought simultaneous with Emma verbalizing it. This was a frequent occurrence, and they attributed it to how closely their lives had coincided. Not only had they grown up several blocks apart in the same neighborhood in Manhattan and gone to the same grammar school, but they had both ended up majoring in criminal justice in college, with Brian attending Adelphi on Long Island and Emma going to Fordham in the Bronx. Although they also had gone to different high schools, their transcripts were remarkably similar. Both had done well academically, and had been very active in athletics in high school and college. For Brian it was soccer, wrestling, and baseball, and for Emma it was field hockey, basketball, and softball.

“Compared to our law enforcement experiences, it must be incredibly boring,” she said as she faced around to look out the windshield. Both she and Brian had matriculated directly into the New York Police Department Academy after college, serving as patrol officers at very busy NYC precincts. After five years of exemplary service, they had been accepted into the elite and prestigious NYPD Emergency Service Unit. It had been when Emma was a cadet at the ESU Academy that their remarkably parallel lives temporally aligned. Brian, who was a member of the ESU A team, volunteered on his days off to help the ESU Academy instructors. It was his way of staying up to date and in shape, and his reward was meeting one of the few female ESU cadets, falling in love, and gaining a wife.

“Especially off season,” he said. “To tell you the truth, I wouldn’t be able to do it. No way.”

They were now passing through mostly pitch pine and black oak forests. They also passed Gull Pond, which was north but near Long Pond, where they had kayaked that morning. As it was their first trip to Cape Cod, they had been pleasantly surprised by the many freshwater ponds with crystal-clear water so close to the ocean on one side and the bay on the other. They’d asked a local about them and had been told it had something to do with glaciers back in the Ice Age.

Gross Hill Road dead-ended into Newcomb Hollow Beach, and as they pulled into the parking lot, they were encouraged. A lot of bedraggled people were heading from the beach to their cars, carrying an enormous quantity of gear, including beach chairs, sun umbrellas, and impressive coolers that made the Murphys’ Styrofoam model seem embarrassingly chintzy. Some were tanned regulars, but most were clearly burned visitors.

“Ouch,” said Emma, looking at one adolescent girl who appeared as pale as the Murphys. “She’s going to be sorry tonight.”

“We’re in luck,” he exclaimed, pulling into a vacant slot remarkably close to the pathway that led from the parking lot to the beach up over an impressive fifty-foot grass-covered dune. As usual, Juliette was excited at the prospect of being on the beach, so she was first out of the car and impatient as Emma and Brian unloaded. Despite her agitation, she was willing to accept carrying the bag of corn and most of her toys in addition to Bunny. While Emma carried the cooler and towels, Brian handled the grill, the briquettes, and the aluminum beach chairs.

It was late afternoon and the sun streaming over their shoulders painted the entire scene in a rich, golden glow. Everyone they passed leaving the beach was wearing their pandemic mask, as were the Murphys. When they crested the dune, Emma and Brian paused to take in the dramatic sight of the wide, sandy beach and the large expanse of the Atlantic. The breeze was onshore, and it carried the sound of the two-to-three-feet-high waves as they broke. Since the tide was going out, there were numerous tide pools, which Juliette loved, since she was a bit intimidated by the ocean. Capping the impressive scene were large cumulus clouds that hung over the vista like dollops of whipped cream.

“Which way?” Juliette called over her shoulder.

“What do you think?” Brian asked Emma.

“I’d say north,” she responded after glancing in both directions. “There’s less people. And there’s a good-sized tide pool directly in front.”

“To your left,” he shouted to Juliette, who had already run down toward the water’s edge.

They set up their camp about a hundred feet north of the path and up against the steep dune embankment. While Brian struggled with the grill, Emma put sunscreen on Juliette before handing the spray can to him. After tossing Bunny onto one of the towels, Juliette immediately bounded off for the tide pool.

“Don’t go in the waves until I’m down there with you,” he yelled to her, and she waved back to signal that she had heard.

“When do you think we should eat?” she asked.

Brian shrugged. “It’s up to you. Just give me fifteen to twenty minutes’ notice to get the briquettes fired up.” He poured them into the grill and closed the lid. “Meanwhile, let’s join Juliette.”

For the next forty-five minutes they ran in the wash from the surf, either chasing or being chased by Juliette. At one point he managed to get Juliette to venture out into the breakers with him holding her hand, but he could tell she really didn’t like it, so they quickly went back to the tide pool. Shortly after, Brian could see that Emma was already back preparing the corn at their campsite, which was now in shadow. Taking the hint, he told Juliette it was time to start the barbecue and that he would race her with him running backward. Delighted at the prospect of beating her father, Juliette took off with a squeal and, mostly thanks to Brian getting a late start, gained a commanding lead.

“I’m afraid we have some unwelcome visitors,” Emma announced the moment they came running back.

“What do you mean?” he asked. He glanced around, mostly skyward. On their previous visit to Newcomb Hollow Beach they’d had a run-in with a few very persistent seagulls and had been amazed at the birds’ boldness.

“No seagulls,” she said, reading his mind. “Mosquitoes.”

“Really?” he questioned. He was surprised, considering the significant onshore breeze.

“Yes, really,” Emma said. “Look!” She raised her left arm and pointed to the base of her deltoid muscle. Poised and obviously preparing to bite was a black mosquito with white markings, but before the insect could do its worst, she slapped it with an open palm. When she pulled her hand away, she could see that the creature was reduced to a tiny bloody corpse, indicating it had already bitten someone else but still wasn’t satiated.

“I don’t think I’ve seen a mosquito like that,” Brian said. “Rather distinctive coloring.”

“I have,” Emma said. “It was an Asian tiger mosquito.”

“How the hell do you know about Asian tiger mosquitoes?”

“During one of my ESU Academy medical lectures, we learned about arboviral disease and climate change. The lecturer specifically talked about Asian tiger mosquitoes, which used to be restricted to the tropics, but now have spread widely northward all the way up to Maine.”

“I never got that lecture,” he complained.

“Times have changed, old man,” she said with a laugh. “Remember, you were two years ahead of me.”

“What’s arboviral disease, anyway?”

“Remember reading about yellow fever and building the Panama Canal? Well, yellow fever is an arboviral disease.”

“Yikes,” Brian said. “Has there ever been yellow fever in the USA?”

“Not since 1905 in New Orleans, if I’m remembering correctly,” Emma said. She abruptly ran her fingers through her hair and then waved her hand above her head. “Uh-oh, I can hear more of the bastards. Aren’t they bothering you?”

“Not yet. Juliette, do you hear any mosquitoes?”

Juliette didn’t answer, but like her mother, she suddenly waved her hands around her head, suggesting she was hearing them.

“Did you bring the bug spray?” Emma asked with urgency.

“It’s in the car. I’ll run and get it.”

“Please,” Emma said. “The sooner the better. Otherwise we are going to be miserable.”

With no further urging, Brian grabbed his mask, jogged down the beach, and then went up over the dune. As he expected, he found the can of OFF in the glove compartment. When he got back to the beach less than ten minutes later, Juliette was again in the tide pool.

“I tell you,” Emma said as she began to apply the repellent, “these winged bastards were aggressive while you were gone. I had to send Juliette down to the water.”

“I tried to be quick.” He took the spray and applied it as Emma had done and then called Juliette back from the water’s edge to protect her as well.

Once the Murphys had the mosquitoes at bay, they were able to get back to their barbecue. The corn cobs went on the grill first, followed by the hamburger patties, and finally the clams. By the time the food was cooked and served, the entire beach was in the shadow of the dunes even though the ocean and the clouds were still in full sun.

After they had eaten their fill and partially cleaned up, Brian and Emma relaxed back into their respective beach chairs to finish the prosecco, have dessert, and savor the view. The setting sun, which was out of sight behind them, was tinting the puffy clouds pink. Juliette had retreated back down to the edge of the tide pool to make sandcastles in the damp sand.

For a while neither spoke. It was Emma who finally did. “I hate to break the spell,” she said, turning to Brian, “but I’ve been thinking. Maybe we should consider heading back to New York a little early.”

“Really? Why? We’ve got almost another week with the cottage.” He was surprised by her suggestion since coming to Cape Cod for vacation had initially been her idea, and they all seemed to be enjoying it immensely. Even the weather was cooperating.

“I’m thinking that maybe if we were back home we could do something to possibly drum up some business.”

“Do you have some new idea of how?” he asked. “What little work we had in the late spring totally dried up in July.”

Eight months earlier, Brian and Emma had retired from the NYPD to start their own personal protection security agency, which they appropriately called Personal Protection LLC. They had begun the firm with high hopes of success, considering the level of training and experience they had after being NYPD ESU officers — Brian for six years and Emma for four years, on top of each having been a regular police officer for five years. At the time of their retirement from the NYPD, both were sergeants and Brian had already passed the exam for lieutenant with flying colors. A consulting firm that they had hired at the end of the previous summer to advise them had projected rapid success and expansion for Personal Protection after supposedly taking all potential factors into account. Yet no one could have predicted the Covid-19 pandemic, which had reduced the demand for their services to almost nothing. In fact, during the last month they’d had no work whatsoever.

“No, I haven’t had any sudden brainstorms,” Emma admitted. “But I’m starting to feel uneasy and guilty about us up here lazing around, enjoying ourselves, not knowing what the hell the fall is going to bring. I know we needed a break after being cooped up all spring with the pandemic, especially Juliette, but we’ve had our fun. I’m ready to go back.”

“The fall is clearly not going to be pretty,” he said. “As soon as the United Nations Week got canceled, I knew all our projections went out the window. That week alone was going to put our company on the map.” With their professional connections with the NYPD, they had had hundreds of referrals, seeing as United Nations Week was an enormous strain on NYPD resources. Back in December they were concerned about having enough manpower to cover even half of the requests.

“Aren’t you worried about how we are going to weather this pandemic with all the talk about a fall surge?” she asked. “I mean, we’re already behind on our mortgage.”

Both Brian and Emma had been thrifty and fiscally conservative even as children. When they started working for the NYPD, they’d saved more than their friends and colleagues, and also invested wisely. When they had married following Emma’s graduation from the ESU Academy and just before Juliette’s birth, they’d been able to splurge on one of the few freestanding, Tudor-revival, single-family homes in Inwood, on West 217th Street. It was a mere block away from her parents’ home on Park Terrace West. The house was their only major asset besides the Subaru.

“A lot of people are behind on their mortgage payments,” Brian countered. “And we spoke with our loan officer. Plus, we do have some cash receivables. The mortgage is not going to cause a problem. I think we’ve made the right choice to keep our cash to cover our other major business-related expenses, like Camila’s salary.”

Camila Perez was Personal Protection LLC’s only employee. When the pandemic exploded in the New York area, she’d moved in with the Murphys and had been living with them ever since. It was one of the benefits of having a house with adequate living space. Over the course of the spring she’d become more like family than an employee. The Murphys had even encouraged her to come with them to Cape Cod, but she had responsibly declined in order to handle anything that came up in relation to the company. During the previous week, there had been a couple of inquiries about Personal Protection providing security for some high-end fall weddings in the Hamptons.

“You are obviously handling this all better than I am,” Emma confessed. “I’m impressed that you’re able to compartmentalize so well.”

“Truthfully, I’m not doing that great. I’m worried, too,” he admitted. “But my worry comes mostly in the middle of the night when my mind can’t shut down. Out here on the beach with the sun and surf, thankfully it all seems so far away.”

“Do you mind if we continue talking about this now, while we’re enjoying this glorious scene? Or do you want me to shut up?”

“Of course I don’t mind,” Brian said. “Talk as much as you want!”

“Well, what’s bugging me at the moment is whether it was a good idea for both of us to leave the NYPD together,” she said. “Maybe one of us should have remained on salary.”

“In hindsight that might have been prudent,” Brian agreed. “But that’s not what we wanted. We both felt an entrepreneurial tug to do something creative and outside the box. How could we have decided who would have the fun challenge and who would have had to continue slogging with the same old, same old? Draw straws or flip a coin? Besides, I’m still confident it is all going to be just fine as soon as this damn coronavirus disaster works itself out. And we’re certainly not alone. Millions are caught in this pandemic squeeze.”

“I hope you are right,” Emma said with a sigh, before quickly slapping the side of her head. “Damn! Those mosquitoes are back. Why aren’t they biting you?”

“No clue.” He reached behind her chair for the can of OFF and handed it to her. “I guess I’m just not as sweet as you,” he said with one of his typical mischievous smiles.

Chapter 2 August 19

It was the raucous sound of a flock of seagulls loudly arguing with one another out in Wellfleet Harbor that awoke Brian after yet another pleasant night’s sleep. Rolling onto his back, he looked out the window through the white sheer curtain fabric, wondering what time it was. He looked at his phone and saw that it was 6:25. Glancing over to Emma’s side of the bed, he saw that she was already up, like almost every morning lately, and he smiled in anticipation of the pastries that would be waiting for him once he got out of bed.

With the birds still squawking in the distance, Brian got up to use the cottage’s single bathroom, but just before entering from the common hall, a glance into the living room surprised him. He could see Emma fast asleep on the couch. Being that she was an early riser, he guessed she’d possibly had a poor night’s sleep, perhaps from worrying about their precarious financial situation, a subject she’d been raising every day since the night of their barbecue. Fearing he was correct, he made it a point to be as quiet as possible. Coming back out of the bathroom, he had another idea that would make it even less likely he’d disturb her. He’d be the one to head out and get the pastries. Whatever the reason was that had her sleeping outside of their bed, he thought she deserved as much time to rest as she wanted.

After silently pulling on some bike shorts and a shirt, Brian checked to see if Juliette was stirring. She wasn’t, which he expected. With the amount of exercise she’d been getting combined with being allowed to stay up later than usual in the evening to play board games, she must have been exhausted. Satisfied, he carried his bike shoes while tiptoeing through the living room. As carefully as he could, he closed the otherwise noisy screen door without a sound, pleased he’d managed to leave without waking his wife.

Cycling past the Wellfleet Harbor, he could see the source of the seagulls’ frenzy, which was still ongoing. Fishermen were cleaning their catches. Beyond the harbor, Brian passed through the attractive downtown of Wellfleet with its well-maintained period buildings, some of which were hundreds of years old, and he was particularly enamored of those with neo-Grecian Doric columns.

Unfortunately, most of the rest of the trip was on the main highway, which lacked the scenery of the smaller roads. But it wasn’t far and there was almost no traffic. To get maximum benefit from the exercise, he cranked up his speed, arriving at the bakery in less than fifteen minutes. Although the shop had yet to open, there were already several people waiting as a testament to its popularity.

Twenty minutes later, Brian was back on his bike, now heading north. When he arrived at the cottage, he returned his bike to the garage and then entered as quietly as possible. To his surprise, Emma was no longer on the couch. Instead, she was now back in their room curled up in a fetal position on the bed, and though her eyes were open, she didn’t stir upon his arrival.

“I feel terrible. I had a very bad night.”

“I’m so sorry, my sweet,” Brian said as he sat on the edge of the bed. “What’s wrong?” He was surprised to see her sick, because she was the most resistant of the three of them when it came to winter colds and other ailments. The usual progression was Juliette first, probably picking up something at preschool or at one of her playdates, and then she’d give it to him. More often than not, Emma wouldn’t succumb, despite being the major caregiver.

“I just feel awful all around,” Emma managed.

“Do you feel feverish?”

“Yes. I’ve had chills and I’ve been sweating.”

Gently Brian reached out and placed his palm on her forehead. There was no doubt in his mind that she was burning up.

“I’ve also been vomiting,” Emma continued. “I’m surprised I didn’t wake you.”

“I wish you had,” he responded worriedly.

“Why?” she said with seeming irritation. “What would you have been able to do?”

“I don’t know,” Brian said. “Just be with you.”

“There’s nothing you could have done,” Emma countered. “I also ache all over, and I have a bad headache and a stiff neck. I’ve never felt this terrible.”

“Can I at least get you an ibuprofen?” He reached out and tried to rub Emma’s back, wanting to help somehow, but she moved away from his touch.

“I suppose an ibuprofen can’t hurt,” she said, resettling herself in the center of the bed.

“Have you had a sore throat, cough, or any difficulty breathing?”

“No,” she said with force. “I know what you’re thinking, but this isn’t coronavirus. I can’t imagine it could be, from what I’ve heard about Covid-19. I also haven’t lost my sense of smell. Nothing like that.”

“Nonetheless, we will have to get you tested for coronavirus,” Brian said calmly. “We have to rule it out.”

“Whatever,” Emma said irritably.

“Are you hungry at all?” he asked. “I’ve brought back almond croissants.”

“I told you I feel sick to my stomach. Do you really think I’d want an almond croissant?”

“Okay, okay,” Brian soothed. “I’ll get you an ibuprofen. Maybe two.” He stood up and went into the bathroom to get the pills, and then into the kitchen for a glass of water. He was a little surprised at Emma’s apparent anger. It wasn’t like her in the slightest. Whenever she felt under the weather in the past, she never acted irritated. If anything, she tended to downplay her symptoms.

After he gave her the pills, she took the medication and then flopped back onto the bed.

“I’m going to find out where the hospital is out here,” Brian said. “Is there anything I can get for you at the moment?” She merely shook her head and closed her eyes.

Out in the living room, Brian opened up his laptop to search for the nearest hospital, thinking that would be the easiest way to get Emma tested for coronavirus. Knowing the variability of the Covid-19 symptoms, he wondered why she was so sure she didn’t have it. One way or the other, they needed to know. He also briefly thought about trying to find a local MD but doubted a country doctor could add much to what he already knew. The medical courses he’d taken at the ESU Academy had been extensive, certainly qualifying both him and Emma to be full-fledged EMTs. If he had to guess, he thought that Emma had most likely contracted a case of food poisoning, possibly from the clams they had had for dinner even though he didn’t seem to have any symptoms. What he hoped was that within twenty-four hours or so, she would be on the mend.

It didn’t take long for him to find out what he needed, and after he had, he returned to the bedroom. She was lying on her back in the center of the bed with her eyes closed.

“Emma?” Brian whispered. If she had fallen asleep, he didn’t want to wake her.

“What?” she said without opening her eyes.

“The closest hospital is Cape Cod Hospital,” Brian said. “It’s in Hyannis, which is forty-five minutes away. I suggest we drive to the hospital as soon as you feel up to it. The sooner you have a coronavirus test, the sooner we’ll get the results.”

“I don’t want to go to some fly-by-night hospital out here in the sticks.” She looked up at him with her hazel eyes on fire.

“I don’t think you’re being fair,” Brian argued. “From what I’ve read online, it seems it’s held in reasonably high esteem. Besides, at the moment all we’re looking for is a coronavirus test.”

“No way! I want to go back to New York. If I need a hospital, I want a real hospital.”

“You really want to go home today?” he asked.

“Yes,” Emma snapped. “I don’t like how I feel and I’m worried I might get worse. This isn’t just some cold.”

“Okay, okay,” Brian said reassuringly. “We’ll head back today. I’ll pack our stuff, load the car, and strap on the bikes and the kayak. Try to take it easy in the meantime.”

Chapter 3 August 19

Packing all their belongings and loading the car took a lot longer than Brian had anticipated. Part of the problem was having to deal with Juliette. Emma’s irritability particularly disturbed Juliette, who didn’t seem to understand why she was being ignored by her mother. As a consequence, he had to spend a lot of time trying to console her and keep her occupied. What worked the best was getting Juliette intimately involved with the packing and loading, but the problem was that it then took far longer than if Brian had been able to do it all on his own.

It was just after eleven when they were finally able to pull out of the driveway and start the five-hour drive back to the Big Apple. Since Juliette’s car seat was behind the driver’s side, Brian was able to lower Emma’s seat back to a reclined position. He’d made some sandwiches and stocked the cooler with water and fruit juice for their ride. He wanted to get Emma home as soon as possible.

For most of the way Brian was on his own, as Juliette was watching cartoons and Emma was sleeping, with her head on the pillow pressed up against the side of the car. A bit of perspiration dotted her forehead, indicating her fever was persisting.

The quiet gave Brian more time to worry anew about the condition of Personal Protection LLC. As he had confessed to Emma, being on vacation in a totally new location had made it possible for him to put work completely out of his mind. But now that they were heading home, all his concerns came flooding back. The reality was that very few wealthy businesspeople who needed security were traveling into the city because of the pandemic, and with the expected fall surge that probably wasn’t going to change. All he could hope for was that one of the rare inquiries they’d gotten about the high-profile fall weddings would pan out to be an actual gig. For that reason, he was looking forward to finding out from Camila if there had been any movement whatsoever toward a possible commitment.

Although traffic had only been moderate without any significant delays, he felt definite relief when they reached the Henry Hudson Bridge. It meant they were almost home, and he was anxious to get Emma into bed and take her temperature. A small amount of sweat had continued to dot her forehead for the entire trip, and he also knew that Juliette was nearing the absolute end of her patience while strapped into her car seat.

So when disaster struck, Brian’s mind was completely absorbed by the details of how he would manage getting both Emma and Juliette out of the car and into the house efficiently. The first hint of a calamity was a peculiar rhythmic thumping coming from someplace under the car’s dash. Within seconds he was aware of movement to his right that coincided with the noise. As his eyes darted in that direction, he realized to his horror that Emma was caught in the agonal throes of what could only be a seizure. Her feet and legs alternately pounded against both the underside of the dashboard and the floorboards of the car. At the same time, she was grotesquely arching her back, straining against her seat belt with her arms wildly flailing and her head slamming again and again against the car’s window.

Practically losing control of the car as he ducked away from Emma’s pummeling left hand, Brian fought with the steering wheel as the vehicle heaved from side to side, tires screeching. The instant he regained control, he slammed on the brakes and with difficulty managed to pull to the side of the road despite angry honking and rude gestures from other drivers. By now, Juliette was screaming.

From his EMT lectures, he knew he had to keep her from injuring herself until her seizure abated, and thankfully the car’s seat belt helped. His biggest concern was her head, which he was able to keep away from the car’s metal frame, letting it hit up against the pillow during her violent contractions. With his other hand he tried to keep her powerful legs from injuring themselves against the dash. The fact that she was in such good physical shape made it that much more difficult. Brian had to use all the strength he had.

Although at the time it seemed interminable, finally her contractions lessened and then abated altogether, and Brian could let her sag back against the seat and the car’s door with her head against the window. Instinctively he knew it had only been a couple of minutes. A bit of blood trickled from her mouth, suggesting she had bitten her tongue, but he could see that she was breathing normally again.

He straightened up in his seat and quickly unbuckled his seat belt. Juliette was crying uncontrollably in the back, so after leaping out of the car, Brian opened the back door, leaned in, and enveloped his daughter in his arms. He told her over and over that all was okay, that Mommy was fine, and that they would take her to the hospital.

“Now Daddy has to keep driving, okay, sweetheart?” Brian soothed at length when Juliette’s tears lessened. Gently he removed her arms from around his head.

Somewhat reluctantly, Juliette let him straighten up. After he gave her shoulder another reassuring squeeze, he got back into the front seat and checked Emma again. She was awake, but seemed disoriented. He told her that they were almost home but that he was going to take her to the hospital, the same hospital where Juliette had been born. He also told her that she had just had a seizure, to which she nodded but didn’t respond audibly.

After exiting the Henry Hudson Parkway at the Dyckman Street exit, it was only a short drive to the Inwood campus of the Manhattan Memorial Hospital. Like all New York City boroughs, Inwood had several hospitals. The Murphys had chosen the MMH, as it was known in the neighborhood, for Juliette’s birth because it was where Emma had had her tonsils removed when she was a child. It was also familiar to Brian. During his second year as an NYPD patrolman, he’d been assigned to the 34th Precinct for a number of months to fill in for someone on sick leave and in that capacity had spent quite a bit of time at the hospital, particularly getting some work on many of his days and evenings off. It had been a way for him to make extra money, as the hospital liked having a uniformed officer on-site. He had spent enough time there that he’d even gotten to know a few of the doctors and nurses on a first-name basis.

“Is Mommy going to stay at the hospital?” Juliette asked as Brian turned off Broadway onto the hospital grounds.

“I doubt it,” he said. “But we have to see what the doctors say. We just want to make sure she’s okay.”

Brian drove up to the Emergency Department entrance and pulled to a stop at the ambulance dock.

“Emma, how are you doing now?” he asked. “Are you okay walking into the hospital or do you want me to get a gurney for you?”

“I’m okay,” she said in a monotone, speaking up for the first time since the seizure.

“Are you sure?” To Brian she still seemed somewhat disoriented, certainly not herself. Even though she didn’t answer, he got out of the car, got Juliette out, and walked around to the passenger side. When he opened the door, Emma made no effort to move, so he reached in and undid her seat belt. He then made sure they all had their face masks on.

“All right,” he said. “Let’s get you inside.” Gently he encouraged her to climb out of the car and with somewhat unsteady legs she walked into the ED holding Brian’s hand for support.

Chapter 4 August 19

As it was 4:30 and getting close to dinnertime, the Emergency Department was only moderately busy. The Murphys had to stand for a short time at the information counter, but when Brian explained why they were there, a pleasant triage nurse immediately ushered them into a treatment cubicle and encouraged Emma to lie down. As she took Emma’s vital signs and got more of a history, a clerk who had accompanied them got their name and health insurance information. The clerk also got Brian to sign a permission-for-treatment form. Once the paperwork was done, Brian and Juliette hurried back outside to deal with the car.

At the car Juliette started crying inconsolably, demanding that she wanted her mommy through near hysterical tears. Although normally quite patient with his daughter, Brian felt unnerved himself, and when she refused to get into her car seat, he had to forcibly control himself. Doing so made him realize that he needed some backup. Although he could have called his mother, Aimée, he chose to call Camila, who’d become almost a surrogate mother for Juliette over the previous five months. As he expected, Camila was horrified when she learned what had happened to Emma and immediately offered to come over to MMH to take charge of Juliette.

“Okay, sweetie pie,” he said to Juliette as he disconnected the call. With help on the way, he felt he had a better hold on his emotions. “Camila is coming to take you home.”

Juliette greeted this news with even more forceful tears, but Brian took it in stride. He knew she would feel better as soon as she was back in familiar surroundings. He picked up Juliette and held her close to comfort her, and though she continued to cry with less intensity, she still pressed her face into the crook of his neck and hugged him forcibly.

In just a little more than ten minutes, Camila arrived. A moment later she was reaching out for Juliette, who was happy to transfer from Brian’s arms to Camila’s. “Oh, my poor baby,” she said while hugging the child. It was obvious she had a strong maternal instinct, and he greatly appreciated her presence in his life in moments like this.

Camila was a thirty-two-year-old first-generation Cuban American with an engaging, upbeat personality, a ready smile, and frequent laughter. She looked more like a teenager than an adult, especially with her preferred dress being fashionably ripped jeans. She was of medium height and build with long dark hair parted in the middle and an olive complexion that both Brian and Emma coveted, as she never had to bother with sunblock. Like Brian and Emma, she had spent most of her life in Inwood, and they shared some common friends. The difference was that she had grown up on the predominantly Latino east side of Broadway whereas Brian and Emma had been on the largely Irish west side.

Like Brian, Camila had gone to Adelphi University but had majored in business, which was the reason she’d responded to Brian and Emma’s employment search. They had specified that they were looking for someone to help with a startup security business. Luckily for both parties, from day one it had seemed a match made in heaven since Camila’s business know-how complemented Brian and Emma’s law enforcement experience. When the pandemic exploded in the New York area in March, asking Camila to move in was an easy decision, as was her decision to accept. She had several aging grandparents living at home with serious health issues whom she wanted to avoid putting at risk.

“I’ll be home with Emma as soon as possible,” Brian told her as he gave Juliette Bunny, which she grabbed and enveloped with a bear hug.

“No worries,” she said. “I’ll grab dinner and make sure Juliette is occupied.”

“I can’t thank you enough. You’re a lifesaver.”

After watching Camila drive away and knowing Juliette was being taken care of, he felt significantly more at ease and capable of dealing with the situation. The first thing he did was go back to the check-in counter to ask if there was any information available on his wife, but all he was told was that the doctor would be out to talk to him shortly.

Brian took a seat as far away from other people as he could, which required moving to the end of the room since the ED was already busier than it had been only fifteen minutes earlier. From his previous experience at the hospital as a uniformed patrolman, he remembered there was always a buildup of activity just before and then another after dinner.

The time passed slowly. To entertain himself he took out his phone, and with some reluctance he called his mother, Aimée. He knew that, as the family matriarch, she would be very upset and insist on helping, possibly by offering to come directly to the hospital, even though it would probably cause more stress than good. But he felt an obligation to let her know what was happening. She answered with her lilting and charming French accent, which she had never lost.

Aimée had grown up in the northern part of France — Normandy, to be exact — and had come to the United States forty-one years ago to attend prestigious Barnard College. It was there that she had met Brian’s father, who happened at the time to be attending Columbia University on a sports scholarship. Aimée’s maiden name was Juliette, a somewhat rare family name even in France, and in her honor Emma and Brian had named their daughter Juliette.

Brian evaded any small talk with Aimée, immediately telling her that he was calling from the MMH ED because Emma had suffered a seizure in the car as they drove into Manhattan following her sudden flu-like symptoms from the morning.

“Oh, my goodness. I’m so sorry to hear,” Aimée said with concern. “Is she all right now?”

“There’s been no word yet from the doctors,” he informed her. “She is being seen as we speak. She walked in under her own power but seemed somewhat disoriented.”

“Do you think she has coronavirus?” Aimée asked.

“I hope not,” Brian said. “Actually, I don’t think so because she didn’t have any of the big three symptoms, like cough, difficulty breathing, or loss of sense of smell. But who knows? She did have a fever. We’ll have to see.”

“And where’s Juliette?”

“Camila came to pick her up just a few minutes ago. We’ve only been here an hour or so.”

“How about you? Are you okay?”

“I’m hanging in there,” he said. “Though I’ll admit it’s been a bit unnerving. This is the first time I’ve ever really seen Emma sick.”

“I can well imagine you’d feel out of sorts. Do you want me to come and keep you company?”

“It’s not necessary,” Brian said. “I’m doing okay now that Juliette is being taken care of. Besides, the hospital is discouraging family visitors with the pandemic going on for obvious reasons. I promise I’ll let you know as soon as I know anything.”

“D’accord,” Aimée said. She had a habit of sprinkling French expressions into her conversations. “I’ll call Emma’s mother and let her know. Of course, she may want to come to the ED. You know Hannah has a mind of her own.”

“Please try to discourage her. I’ll let you know the moment I learn anything, and you can let her know.”

After speaking with his mother, he debated whether to call his two older brothers or his younger sister, more as a way of keeping his mind occupied than anything else. While he was still debating, he heard his name called out by a tall, slim, relatively young doctor who’d stepped into the waiting room from the depths of the ED. Dressed in rumpled scrubs, a surgical hat, and face mask, he looked the part of a harried emergency physician with a raft of pens jammed into his breast pocket and a stethoscope slung around his neck.

Brian stood up and waved to get the doctor’s attention.

“Mr. Brian Murphy?” the doctor questioned yet again as he neared. He had lowered his voice considerably. “You are Emma Murphy’s husband?” He had a lilting accent Brian associated with people from the Indian subcontinent.

“I am,” Brian responded. He felt himself stiffen, sensing from the doctor’s tone that all was not well.

“My name is Dr. Darsh Kumar. I have important news about your wife.”

“Okay,” Brian said slowly, bracing himself for what he was about to hear.

“She’s going to be admitted to the hospital. In fact, she has to be taken to the Intensive Care Unit.”

“Okay,” he repeated, feeling increasingly panicked but trying to calm himself. “Why the ICU?”

“She had another seizure while she was being examined,” Dr. Kumar explained. “However, we were able to control it rapidly since we already had an IV running. She’s resting comfortably now, but is disoriented. We want her to be closely monitored.”

Brian nodded. His mind was racing around at warp speed. “More disoriented than when she arrived?”

“Probably, but not necessarily. I can’t say for sure.”

“Is there a diagnosis? Could this be coronavirus?”

“It’s possible, but not probable with these symptoms,” Dr. Kumar said. “What we are certain of is that she has some sort of encephalitis, meaning an inflammation of the brain.”

“I’ve heard of encephalitis. I’ve had EMT training,” Brian explained.

“What we don’t yet know is the specific etiology,” Dr. Kumar continued. “We suspect viral. We did a spinal tap and have sent the specimens to the lab. They will soon let us know what we are dealing with. If I had to guess, I’d say possibly something like West Nile virus or possibly even Lyme disease. Did you have much contact with mosquitoes or ticks while you were on Cape Cod?”

“No ticks, but we did have some mosquitoes during a beach barbecue four or five days ago.”

“That could be it, which would favor a viral disease. But there is no reason to speculate at this point. It won’t change our treatment.”

“What’s the treatment?”

“Essentially just supportive. She’s on supplemental oxygen. Even though we were able to stop her seizure quickly, her oxygen level fell considerably.”

“Can I see her?” Brian asked desperately.

“Not at the moment,” Dr. Kumar said. “She’s getting an MRI and a CT scan.”

“Both? Why both?”

“I leave that up to our radiology colleagues. Meanwhile the business office needs to speak to you about your wife’s admission.” He pointed across the room to a door that had admitting stenciled on it, and then turned and started to leave.

“Excuse me,” Brian called after him. “I would like to see my wife when I can.”

“I’ll let the nurses know,” Dr. Kumar said over his shoulder before quickly disappearing whence he came.

After taking a deep breath to fortify himself, Brian picked up the few things he had brought in with him and walked over to the Admitting office. He had no idea what they wanted from him since he’d already given their information to the ED clerk.

It was a reasonably sized room with several rows of chairs facing two desks. On the cream-colored walls were multiple framed photographs of mostly serious-looking men in business suits although there were several women. He assumed they were hospital administrators. Only one of the desks was occupied, by a middle-aged woman with dark hair and eyes. She was wearing a colorful flower-print dress under a white lab coat.

“Mr. Murphy?” the woman called out as soon as Brian entered. She and Brian were the only people in the room.

“Yes,” he said. “Brian Murphy.” He could see her name was Maria Hernandez. He approached her desk, where a large plexiglass shield had been added in recent months. Like a cashier’s window at a bank, there was a slot for passing papers to and fro along its base.

“Brian Murphy,” Maria repeated while tilting her head to the side to give him a good once-over. “Were you related to Deputy Inspector Conor Murphy, the commanding officer of the 34th Precinct, by any chance?”

“He was my father,” Brian said, surprised that she recognized him with his face mask. Luckily the short time Brian had been assigned to the 34th Precinct was before his father had become the CO.

“I knew it the moment you walked in here,” Maria said, as if proud of herself. “You’re certainly your father’s son. My husband, Adolpho, who was the sanitation supervisor for Inwood, knew your father very well. In fact, they shared many an after-hour beer.”

“Unfortunately, my father shared far too many beers,” he responded. He didn’t want to be reminded of that aspect of his father, who ultimately fell victim to the Irish curse of alcoholism and had died a year and a half earlier. At the same time, Maria’s comment reminded him of the benefit as well as the disadvantage of living within one of the many tight-knit New York neighborhoods. Lives were inextricably intertwined.

“Isn’t that the truth,” Maria said grimly. “Same can be said about my Adolpho, bless his soul. Aren’t you a policeman, too?”

“I was. In December I left the force to start my own business. One of my brothers is a cop and so was my uncle, grandfather, and great-grandfather.” Brian had loved being a policeman and had longed to become one for as long as he could remember. But part of the reason he left the force was to avoid the trap that had ensnared his father, grandfather, and great-grandfather. The security business had been a way to use his law enforcement background and experience in a new and creative way, without it becoming too routine or depressing.

“And who is this Emma Murphy?” Maria said, holding up the admission papers.

“That’s my wife,” Brian said. “Emma O’Brien. You probably know her father and mother. Her father started Inwood Plumbing and Heating.”

“Yes, I know of her. I’m sorry she’s being admitted, especially to the ICU.”

“I am, too. What do I need to do here?”

“Just sign these admission forms for me,” Maria said. She slid the stack of papers through the slot in the plexiglass.

He leafed through the stack, and he could see it was the usual legalese that he detested and for which he had little patience. It reminded him of income tax forms. “What is all this?” he asked.

“The customary material. It’s mostly to give the hospital and our fine doctors and nurses the right to take care of your wife. It also means you are agreeing to pay for the necessary services.”

“Does it have our health insurance information?” Brian asked.

“Whatever you gave to the ED clerk, I put in there,” Maria said. “Slip it back to me and I’ll make sure.”

Brian did as he was told. Using her index finger, Maria rapidly flipped through the pages. In a moment she’d found the correct one. “Yes, here it is. Peerless Health Insurance with the policy number. You’re fine.”

“Okay, good,” he said with relief. “Let me sign it.”

Maria shoved the pages back through the hole in the plexiglass. While Brian was signing, she asked: “Why do you have Peerless insurance? Why don’t you have your official NYC insurance? I mean, you were a policeman for years, right? I still have my Adolpho’s plan. It’s really terrific.”

“When Emma and I left the force to start our company, which was far more expensive an undertaking than we thought, we had to pinch pennies. We couldn’t afford the premiums to keep our NYPD insurance, so we turned to the short-term market. Peerless offered what we needed. We felt obligated to be covered because of our daughter. She’d been a preemie.” He slid the signed document back through the plexiglass.

“It does seem to be a quite popular company,” Maria agreed. “I’ve seen a lot of it lately. Okay, you are good to go, and I hope Emma gets better quickly.”

“Thanks, Maria. Nice chatting with you.”

Brian returned to the main waiting area. As someone who was a committed “doer,” he found this kind of inactivity a strain. Yet he couldn’t leave without having more information and reassurance about Emma’s condition. To make certain that the powers that be knew he was still there, he went back to the information desk and essentially rechecked in. He told the clerk that Dr. Kumar had informed the nurses that he wanted to see his wife as soon as her MRI and CT scans were done. The clerk assured him that the nurses would surely let him know the moment they could. With a strong suspicion the woman was merely placating him, he nonetheless took a seat as far away from everyone as possible and committed himself to waiting.

Another hour crept by. Brian watched as an endless cast of characters either walked into the ED or were carried in. Some came with extended family, most of whom were denied entry by the security people because of the coronavirus situation. Under less stressful circumstances he might have found the scene mildly entertaining as a reflection of life in Inwood. He even recognized some of the patients or the accompanying family members, but he didn’t talk to anyone, preferring to hide behind his mask and just observe.

“Mr. Murphy?” a voice asked.

Brian turned away from the scene of another ambulance arriving to find himself looking up into the masked and shielded face of Ms. Claire Baxter, RN, as evidenced by her name tag.

“Yes, I’m Brian Murphy.”

“Dr. Kumar said you’d like to see your wife before she is transferred upstairs. Come with me.”

He quickly got to his feet and followed the nurse back into the Emergency Department’s busy hinterland. He was shown into one of the larger treatment rooms, where Emma was seemingly asleep on a gurney with its rails raised. To his great relief she looked entirely normal save for a nasal cannula providing oxygen and a stocking cap covering her red hair. She even had a very slight but healthy-looking tan on her normally porcelain cheeks, which made the IV and an oximeter on one of her index fingers look totally out of place. Dr. Kumar was busy studying MRI images on a flat-screen monitor.

Brian approached the gurney and closed his fingers around Emma’s forearm, hoping that she’d wake up. She didn’t budge.

“She’s sleeping off the considerable medication we gave her to control her seizure,” Dr. Kumar explained, speaking rapidly. He quickly moved around to the other side of the bed. “She is still quite disoriented, but I’m happy to say that her oxygen saturation now is entirely normal. That means her lung function is steady, which we feel lessens the chance we are dealing with coronavirus or will be in need of a ventilator. She tested negative for SARS-CoV-2, by the way.”

“That’s encouraging,” he said. “What did the MRI and the CT scans show?”

“Both are consistent with viral encephalitis,” Dr. Kumar said. “More importantly I spoke with an infectious disease specialist. She told me that considering the history of you and your wife having just been on Cape Cod and that beach incident you recounted, she’d favor a diagnosis of eastern equine encephalitis rather than West Nile, which we’ll be testing for. She reminded me that Massachusetts has seen an uptick in EEE over the last couple of years.”

“I’ve never heard of EEE.”

“You and a lot of other people,” Dr. Kumar said. “But that’s going to alter with climate change. Mark my words.”

“Is EEE serious?” Brian asked hesitantly, not sure he wanted to hear the answer.

“Yes, it can be. Particularly when there are neurological symptoms.”

“Like my wife is experiencing.”

“Like your wife is experiencing,” Dr. Kumar agreed. “It’s why I want her in the ICU. I want her to be closely observed, particularly for more seizure activity and changes in her orientation and oxygenation level.”

“How long do you think she will be in the ICU?” Brian asked. “I think it might stress her out even more.”

“With luck, just a few days,” Dr. Kumar said. “One of the ICU hospitalists will call you in the morning and let you know how she is doing.”

“I appreciate that,” he said. “Tell me, is EEE contagious?”

“Not from person to person,” Dr. Kumar assured him.

“At least there’s that,” Brian said.

“It’s a mosquito-borne illness, which, simply enough, means it’s becoming more and more important to avoid mosquitoes. Especially during evening barbecues like you mentioned. That’s when those Asian tiger mosquitoes are out in force.”

At that moment several orderlies appeared. Without a word one went to the head of Emma’s gurney, where he disengaged the brake, while the other went to the foot and began guiding it out of the treatment room. Brian was able to follow and quickly give her arm one more squeeze before watching her disappear from the room. He couldn’t help but wonder when he would be seeing her again, especially since he assumed that ICU visitation was most likely limited these days.

“I can show you back to the waiting room,” Ms. Baxter offered.

Brian merely nodded and followed the nurse, passing out through the same door as Emma had just been pushed, but turning in the opposite direction once out in the hallway. He’d hoped to feel more encouraged after seeing Emma for himself, but he didn’t. He also didn’t respond to the nurse’s small talk, too distracted by a wave of anger directed at fate. First it had been the coronavirus that had derailed all their carefully laid plans for their new security business. And now it was this illness he’d never heard of threatening his wife. And to make matters worse, it happened while they were trying to make the best of a difficult situation by having a bit of family fun in the face of the pandemic.

Five minutes later Brian started the short walk from MMH to his home on West 217th Street. Just getting out of the hospital helped his mindset to a degree. Yet he still felt as if he’d run an emotional marathon. Transitioning from yesterday to today boggled him. He couldn’t imagine two days being so different. Yesterday he’d been capable of feeling relatively happy despite the obstacles they faced, and today he was overwhelmed with worry about Emma.

When he walked into the house, he was relieved that Juliette was already fast asleep in bed. He’d been concerned about how he would find the patience to deal with her needs. Camila said she hadn’t eaten much dinner but had been eager to go to bed after having a long bath.

“You are more than a lifesaver, you’re a godsend,” Brian told her after looking in at his peacefully sleeping daughter clutching her beloved Bunny. “You certainly have a way with her that I’m so thankful for. As hard as she was crying at the hospital, I was worried she’d be up all night.”

He closed Juliette’s door silently to avoid waking her.

“She’s a joy,” Camila said. “Emma’s seizure and then the hospital frightened her, and she just needed to get home to calm down. How is Emma?”

“I only got to see her for a few seconds,” Brian said. “She was sleeping off some medication, so I wasn’t able to speak with her.”

“I’m sure she is going to be just fine. Did they give you any idea when she might be coming home?”

“No, they didn’t. I guess we’ll just have to see how it goes and keep our fingers crossed.” He didn’t mention that Emma had had a second seizure. He wasn’t sure why, although he guessed it was because he was trying to forget it.

“How about we have some dinner?” Camila suggested. “On the way home from MMH I picked up enough take-out from Floridita for the three of us: pulled pork, black beans, and yellow rice. Juliette didn’t do it justice.”

“That was thoughtful,” Brian said. “The idea of dealing with food hadn’t even occurred to me. What did we do to deserve you?”

“I think the feeling’s pretty mutual,” she said with one of her characteristic laughs. “It’s been a real win-win situation.”

Over dinner Camila shared some good news. She said that she’d gotten a serious inquiry that afternoon about security needs for a weekend-long wedding planned for the middle of October out in Southampton. “Apparently it’s going to be a sizable affair with people flying in on their private jets from all over the country. The man’s name is Calvin Foster of Priority Capital. He made the call himself, which impressed me. He asked to speak to you directly and gave me his number. I told him that you would call him back tomorrow.”

“Wow,” Brian said. “Did he say anything at all about Covid-19 restrictions?”

“He did,” Camila said. “Everyone will be required to be tested before arrival, and he’s going to have an on-site testing setup.”

“Whoa! That is good news,” he said. “A big wedding like that will be a significant financial shot in the arm, especially if we will be tasked to take care of some of the guests as well.”

“The number to call is on your desk in the office,” she said. When Emma and Brian had started Personal Protection LLC, they’d turned the home’s formal dining room into a dedicated office with desks for all three of them.

“Did he happen to mention how he got word about us?” Brian asked. The conundrum of publicity from day one had only been made worse by the lockdown. Lately they had only been doing online advertising and not even much of that. With people staying at home, there was simply no real need for security.

“He did. He said he’d gotten the number from Deputy Chief Michael Comstock.”

“Really? Terrific! That’s encouraging,” he exclaimed. Deputy Chief Michael Comstock was the commanding officer of the Emergency Service Unit of the NYPD. Brian had served under him for the six years he’d been with the unit and Emma for four. When Brian and Emma had resigned from the NYPD, they had been mildly concerned the CO was resentful, since he skipped their departure party without any explanation. The fact that he was now recommending Personal Protection was a very good sign.

After dinner, while Brian cleaned up the kitchen, Camila went back to the office to work on their accounts receivable in hopes of scaring up some receipts. A bit later he joined her to do some research on eastern equine encephalitis. After he spent some time reading about it, he wished he hadn’t, especially given the paranoia about viruses engendered by the Covid-19 pandemic. EEE was a very alarming illness with a variety of possible consequences, and now that his beloved wife had possibly contracted it, he had a nagging fear that they would be facing a long road to recovery.

Chapter 5 August 20

It was one of the worst night’s sleep Brian could remember having. He kept waking up, tossing and turning, wondering how Emma was faring in the ICU. He hoped that the heavy medication they had given her to stop her second seizure kept her asleep, so she wouldn’t be tormented by the stressful environment. At just after four a.m. he was wandering around the house for the second time, arguing with himself about whether to call the hospital and check on Emma’s status. Ultimately, he didn’t call, not because he didn’t want to but because he doubted he’d get through, and the effort might make him feel even more frustrated and nervous than he already was.

By eight o’clock both Juliette and Camila were up, and while Juliette watched cartoons, Brian and Camila had coffee in the breakfast nook. He told her what a bad night he had had, and she wasn’t surprised.

“I think it would be best if you try to keep yourself as occupied today as possible,” Camila said in response. “Make that call to Calvin Foster. It would be terrific for multiple reasons if you could secure us a major security engagement. It would keep Personal Protection moving in the right direction.”

“That’s the understatement of the year,” Brian said. “Good suggestion. I’ll make the call for sure. How about you?”

“I think I’ll concentrate on keeping Juliette happy and calm,” Camila said. “She is going to miss Emma terribly. I know because my mother was hospitalized with pneumonia when I was about Juliette’s age, and I still remember how devastated and abandoned I felt.”

“She is suffering,” he agreed, glancing over at Juliette. “I can tell. I didn’t know four-year-olds could get depressed, but she’s acting that way. Usually she wakes up a ball of energy. This morning I found her in her bed awake, just lying there and staring into the distance. Let’s be more lenient than usual with the cartoons.” Under normal circumstances Juliette’s screen time was sharply limited, but they needed something to keep her distracted.

“I agree,” Camila said. “Since there’s nothing for me to do in the office and since it’s a nice summer day, I’ll take her out to Isham Park this morning to let her get some exercise. She loves climbing on the rocks.”

“Great idea to get her out and active,” Brian agreed. “I’ll make an effort to take her to the Emerson Playground after lunch, which she also likes, particularly the swings.”

By nine o’clock, with Camila and Juliette out of the house, he parked himself at his desk in the home office. The first thing he did was google Calvin Foster and Priority Capital. He was duly impressed. It was one of the larger New York private equity firms and had a stellar record, and Calvin Foster was considered a particularly sharp financier and shrewd investor. Just when he was about to try to call him, Brian’s phone rang. It was Dr. Gail Garner, one of the MMH intensivist physicians.

“Mrs. Murphy is doing well. Although she has a low-grade fever, her other vital signs are normal and stable. The problem is that she is still not entirely oriented to time, place, or person, although that seems to be slowly improving. We are pleased that her respiratory status is entirely normal without the need for ventilatory support and, as I believe you already know, her coronavirus test was negative.”

“Has a diagnosis been confirmed?” he prodded.

“Yes, it has. As predicted, she’s positive for eastern equine encephalitis, or EEE.”

Brian swallowed as his throat had suddenly gone dry. After what he’d read on Wikipedia the night before, he’d hoped for a different diagnosis, and the terrifying feeling of serious impending consequences came back in a rush. The fact that she was having neurological symptoms was not a good sign. It seemed unbelievable to him that apparently due to climate change his wife had come down with a serious viral illness he’d never even heard of.

“As required, we have reported this case to the New York State Health Department,” Dr. Garner continued. “You might hear from them for more information, although we were able to tell them that the patient had recently been on Cape Cod, Massachusetts, and had reportedly been exposed to mosquitoes. Do you have any questions for me?”

“Can I visit her?”

“I’m afraid that with the Covid-19 situation, visitation in the ICU has been restricted.”

“I assumed as much,” Brian said. “How long do you think she will be kept in the ICU?”

“Perhaps another twenty-four hours. If she stays stable, we will send her to a normal hospital room. She’ll be having a neurology consult today, which might influence timing depending on what they find.”

“Will I be kept up to date on her progress?”

“If there are any changes, absolutely,” Dr. Garner said. “And I can call again in the morning if you would like.”

“I’d appreciate it,” Brian said.

After hanging up, he found himself literally shaking at what he’d just found out. He didn’t even want to contemplate what could be in store for Emma.

Feeling obligated and with trembling fingers, Brian put in calls to his mother, Aimée, and Emma’s mother, Hannah, to tell them what the hospitalist had told him. Both had more questions than he could answer, and he promised he’d let them know as soon as he heard any updates.

After taking a deep breath to try to calm himself, he placed a call to Calvin Foster, desperate to think about something else besides Emma’s situation. Luckily it turned out that not only was Calvin Foster seemingly a first-class financier, he was also personable, easy to talk to, and informed. What was particularly helpful was that Brian didn’t have to sell himself. After only a few minutes of conversation it was apparent that Calvin knew a great deal about Brian’s NYPD background, including his time in the Emergency Service Unit’s elite A team.

“How do you know Deputy Chief Comstock?” Brian asked. As the conversation progressed, it became apparent he and Calvin were more than acquaintances.

“I’ve known Michael since high school,” Calvin said jovially. “He’s the one who recommended your security firm. I must say, he was full of praise. He said you’d gotten a few awards for exemplary service as a policeman.”

“A lot of officers get awards,” Brian replied. He was never one to brag or boast, mainly because he always thought he could do better no matter what others thought of him.

“I even heard you won a sniper award when you were an ESU cadet,” Calvin commented.

“Luckily that’s a skill that doesn’t have a high demand.”

Calvin laughed. “No, I suppose that’s true. Nonetheless, I’m impressed.”

“So, how can I help you?” Brian asked, eager to get down to business.

“I’d like to know if your company could cover my daughter’s wedding that we’ve scheduled for the middle of October despite the pandemic. It’s kind of a ‘hurry-up’ affair that we’re throwing together but still trying to keep safe. It’s going to be outside under an open tent. Kids today live in a different universe than you and I occupied, if you know what I’m saying.”

“And it’s only getting more different every day. I understand the affair will be at your Southampton summer home?”

“That’s the plan. I’ve been told there will be about fifty guests with about half flying in private, some with their own security. Do you have adequate personnel to handle a job like this?”

“Our business plan is to utilize off-duty NYPD Emergency Service Unit officers, of which there are always a sizable and eager number. I’m certain we could provide the required security.”

“Wonderful. What I would like beforehand is a security evaluation and an estimated budget. How soon might you be able to provide that?”

“First, I’d need a guest list with contact information, and I’d have to make a site visit to your Southampton home to view the venue. I can do that in the next few days.” Brian welcomed the idea of the diversion, yet he wasn’t entirely sure he’d feel comfortable leaving town with Emma in the hospital, even though Southampton was only two hours from the city.

“I’ll have one of my secretaries email the Southampton address and guest list to you today, and I’ll let my wife know to expect you. She’s been living out there along with one college-aged daughter full-time since March, and I’ve been going back and forth.”

After setting up plans to reconnect after Brian submitted his security evaluation and budget, they disconnected the call. The second he put the phone down, concern about Emma flooded back.

“Good God,” he murmured, wondering if he could handle this potentially complicated engagement requiring interfacing with other security people while dealing with the stress of worrying about what Emma’s status might be in mid-October and without her business input. Personal Protection LLC had always been something they were to do together, but Brian would have to find a way to fare on his own.

Chapter 6 August 20

It was after one o’clock in the afternoon when Brian and Juliette started walking home from the Emerson Playground. It wasn’t far, only five or six blocks. Try as he might, he had been unable to get Juliette to do anything at the playground. Instead, she sat with Brian on a park bench holding Bunny, content to watch the other children play. To Brian she seemed completely out of character, acting listless and disinterested. Eventually he ran out of things to talk to her about, especially since he had admitted early on that he didn’t know when Emma would be coming home from the hospital.

“We’re home,” he called out the moment they entered the front door. In response, Camila quickly emerged from the dining-room-cum-office to welcome them as they took off their shoes.

“How was your time at the playground?” Camila asked Juliette with forced positivity. “Did you have fun?”

“I want to watch cartoons,” Juliette declared, ignoring the question and heading for the kitchen.

Brian and Camila exchanged a concerned glance. “She’s not happy,” he mouthed. “She didn’t want to play with the other kids.”

“It was the same this morning at Isham Park,” Camila said with resignation. “I’ll see if I can interest her in a bite of lunch.”

“Any communication from Calvin Foster’s people while I was out?”

“Yes, there’s an email with the venue address and a preliminary guest list. There was also a call from the hospital.”

“Really? Was it one of the doctors?” Brian asked nervously.

“No,” Camila said. “It was a Roger Dalton from the hospital business office. He requested a call back as soon as you can. I left his direct-dial number on your desk.”

“The business office?” he questioned. He felt relieved but curious. “What do they want?”

“He didn’t say. He just said for you to call. Apparently, it is something important.”

Brian nodded. He couldn’t imagine what it was about since he’d already spoken with Maria Hernandez and had signed the admission papers. Sitting at his desk and with the number in hand, he took out his cell phone and dialed. The line was answered quickly by a commanding, whiskey-baritone voice with a strong New York accent. Brian identified himself and mentioned that he’d gotten the message to call.

“Yes, thank you for getting back to me,” Roger said. “I’ve been assigned as the case manager for Emma Murphy. A problem has developed. I think it is best if you come into the hospital, so that we can discuss it in person.”

“What kind of a problem? Is Emma okay?” Brian asked urgently.

“It’s a problem with your health insurance coverage.”

“I gave all the appropriate information to Mrs. Hernandez and signed the admission papers. Have you spoken with her?”

“This is not about Emma Murphy’s admission to the hospital,” Roger said. “It’s about her visit yesterday to our Emergency Department, and I need to speak to you directly to set up a payment plan.”

“What are you talking about? What kind of ‘payment plan’?”

“I can explain it far better in person. I see that you live here in Inwood, so it shouldn’t be too much of an imposition for you to come in? I will be here all afternoon.”

Suddenly Brian realized the line had been disconnected and that the man had hung up. With a sense of impatience, he put the phone down. He didn’t know whether to feel irritated or concerned, and what tipped the balance was a mild worry about the possible impact on Emma’s treatment if he didn’t comply. He didn’t think that would really happen, but the mere thought of it made him decide not to make an issue of the situation. Instead, he got up, told Camila that he had to return to the hospital to visit the business office, and set off.

As Brian entered through the main entrance, he could see multiple ambulances pulled up to the ED dock. The main lobby was moderately full, and he had to wait for his turn at the information desk. From his time at the hospital when he’d done off-duty patrolman work, he knew where the hospital administration offices were, but he didn’t know if Roger Dalton’s business office would be there as well. He found out quickly enough that it was.

Moving from the impressively renovated but cold marbled lobby into the admin section of the hospital was a stark transition. Now footsteps were muffled with carpet and the forest-green walls were hung with real art. To him the area looked more like a prosperous international corporation rather than the nerve center of a city hospital. There was even a glass-fronted conference room with a large mahogany library table and captain’s chairs that looked to Brian more like it belonged in a bank. Next to the conference room was what he assumed was the hospital’s CEO’s office, outfitted as impressively as the conference room. As a police officer, he’d met the hospital president at the time, a doctor who had transitioned to administrative work, but Brian knew that had changed when the Inwood Community Hospital was purchased by the Manhattan Memorial Hospital corporation eight years earlier and became MMH Inwood. Under new management, it had undergone a major makeover before officially joining the ranks of the hospital chain.

Asking directions from one of the many secretaries, he quickly found Roger Dalton’s office, but then he had to wait for a time while Roger finished with someone else. Finally, after nearly twenty minutes, Dalton appeared in his office’s doorway and beckoned for Brian to enter.

Brian’s first impression was that Roger Dalton didn’t look anything like his imposing baritone voice implied. Instead of a commanding figure, he was a tall, thin man whose sports jacket looked more like it was draped over a metal hanger than over a pair of shoulders. His face behind his mask looked haggard, and he had deeply set eyes behind heavy-rimmed glasses. With slicked-back hair streaked with gray, he looked like a man who was either a heavy smoker and drinker or battling a serious illness.

“Thanks for coming,” Roger began while taking his seat behind his desk and directing Brian to a chair front and center. “You’re probably wondering why I insisted you come in. I’m afraid I have some bad news for you.”

Although Brian knew from his call that Roger wasn’t talking about Emma, for a second his heart stopped until Roger added: “... your insurance carrier, Peerless Health Insurance, has declined to cover your wife’s $27,432.88 Emergency Department bill.”

“You have already heard from Peerless?” Brian asked. He was astounded by Roger’s comment on many levels, but for the moment the speed with which it had been discovered that Peerless wasn’t paying took precedence. Emma had only been admitted yesterday, and he assumed the insurance matters took weeks, if not months.

“Yes, we have,” Roger said. “As you might be aware, hospitals are being financially stressed through this pandemic. Our usual major sources of operating income such as elective surgery have been curtailed, forcing us to be strict in other areas, particularly the ED, whose operating costs are enormous. I was distressed when I saw that your carrier was Peerless. Our experience with them has been difficult at best, so I wanted to file the claim as soon as possible. True to form, they let us know immediately they were declining the claim, which I’m afraid to say is their normal modus operandi. It seems Peerless often finds creative ways of avoiding paying claims.”

“Why would they decline my wife’s ED visit?” Brian asked, still perplexed. “That doesn’t make any sense.”

“As I said, Peerless is particularly creative,” Roger said. “But my guess in this particular instance is that the rationale is pretty straightforward. Even some of the big insurers like Anthem and United are getting involved. Here’s the deal. There is a lot of talk of the cost of healthcare needing to be curtailed, and that insurance companies have an obligation to put on the brakes or at least appear to be doing so. One area that stands out is the ‘emergency’ overuse situation. Running emergency departments, particularly Trauma 1 centers like ours, is very, very expensive, and far too many people are abusing them for non-emergency ambulatory care rather than for true emergencies, like heart attacks, strokes, massive trauma and bleeding, and the like. Many insurance carriers feel that they have to put a stop to such abuse by denying claims, especially during normal business hours when patients can see their general practitioners or visit small, independent urgent-care centers.”

“You mean that Peerless is saying my wife, who had suffered a grand mal seizure, shouldn’t have come to the MMH Inwood ED?”

“That’s exactly what I believe they are saying by denying the claim,” Roger affirmed.

“Well, that’s preposterous,” Brian sputtered. “A grand mal seizure is surely a medical emergency.”

Roger shrugged his narrow shoulders and spread his hands, palms up. “I’m afraid that is going to be between you and your insurance carrier. Meanwhile, there is this sizable bill that needs to be addressed. That is why we need to set up some sort of payment plan going forward, especially now that your wife is an inpatient and using significant resources like an intensive care bed.”

Brian’s thoughts were churning a mile a minute in every conceivable direction. How could this be happening to him? Was his wife’s care now in the balance because of their irresponsible insurance carrier? The whole situation was ridiculous, and mind-boggling.

“Well, what has Peerless said about my wife’s hospitalization?” Brian managed to ask while trying to rein in his thoughts.

“They have said nothing because they have yet to be billed for that,” Roger said. “Here’s what I propose. If you were to, say, pay five thousand a month, we would be willing to accept that without adding interest. We realize that this is an imposition to anyone’s budget.”

“Imposition?” Brian exclaimed. “You don’t understand. I don’t have that kind of money, and certainly not under these circumstances.”

“Well, you tell me what kind of time frame you have in mind,” Roger offered, tenting his fingers, elbows on his desk.

“Well, first, let’s talk about this bill,” Brian snapped. “Twenty-seven-something thousand dollars! How in heaven’s name did the bill come to that? I could buy a new car for that kind of money.”

“That’s easy,” Roger said. “It’s par for the course and certainly not out of line. As I mentioned, Emergency Department care is very expensive. Your wife had multiple radiographic studies, a spinal tap, various consults, expensive pharmacological agents, many sophisticated laboratory tests, and her care tied up a number of highly paid nurses and doctors. She also had a seizure while being attended, which had to be treated. It adds up quickly.”

“I want to see a copy of the bill,” Brian demanded.

“You can request a copy from the billing department. That’s certainly your right.”

“I want to see a copy right here and now,” Brian said. “It’s all computerized, so it can be printed out in minutes.”

“The way it will immediately print out won’t be understandable to you.”

“I don’t care,” Brian countered. “I want to see it.”

“Suit yourself,” Roger said. He picked up the phone and made a quick call. It was obvious that he was now finding the meeting almost as vexing as Brian.

While Roger was on the phone, Brian tried to calm himself. He realized he needed to talk directly to Peerless. It was absurd to think that a health insurance company wouldn’t cover an obviously necessary ED visit even if some other people abused the situation. It had to be some kind of misunderstanding. Maybe they didn’t know there had been several seizures involved, as well as a serious diagnosis thereafter.

“Okay,” Roger told him, hanging up the phone. “I’ll have a copy of the bill in short order.”

“Can the ED bill be added on to the bill that will be generated by my wife’s admission?”

“No, it can’t,” Roger said. “The ED bill must be taken care of separately. Can you give me an idea of what kind of time frame you would be able to propose?”

“I’m even behind on my mortgage,” Brian blurted. “With the pandemic tying the economy in knots, how the hell do you think I can come up with twenty-seven thousand dollars within any conceivable time frame without being a goddamn fortune-teller?”

“Please, calm down,” Roger snapped. “Let’s try to have a civil conversation.”

“You’re right,” Brian said. He had to get himself under control. “You’ll have to excuse me. I’m just blown over by this whole situation. I never thought about any of this. I’ve always had good health insurance. I guess I’ve just taken it for granted. What I need to do is talk directly with Peerless and get them to step up to the plate and take care of this.”

“That is a good plan, but you have to do it right away,” Roger insisted. “You can’t put this off. Talk to your carrier and then get right back to me. As I’m sure you understand, MMH has its own financial responsibilities it has to meet on a daily basis.”

After a knock on Roger’s door, a secretary came in with a small stack of papers and handed them over to him before retreating. Roger briefly glanced at them and then handed them over to Brian. “Good luck,” he said as he did so.

Brian took the papers and glanced through them. It was immediately clear that Roger had been correct. The bill was entirely unintelligible, with every page mostly composed of long lists of alphanumeric entries followed by dollar amounts. Disgusted, Brian tossed the stack onto the desk. “It’s not in English. It’s all in goddamn code!”

“I warned you that it would be incomprehensible.”

“Why is it in code? Why isn’t each procedure or product just listed with a price? This format doesn’t make any sense.”

“Prices are proprietary information,” Roger explained. “We have to keep that information confidential for our negotiations with insurance companies.”

“I don’t follow,” Brian said. “Isn’t there one specific price for every product and procedure?”

Roger scoffed at Brian’s naivete. “There are different prices for different insurance companies. It’s all a matter of bargaining. Surely you must know this.”

“That’s crazy,” Brian said. “I’ve never heard of such a thing. Do I get a chance to bargain?”

Roger genuinely laughed, although he was obviously losing patience. “No, you don’t get a chance to bargain. As an individual, you have to pay full freight.”

“Why is that? Why do I have to pay more than health insurance companies for the same service?”

“This is how American hospital-based medicine works,” Roger snapped. “I don’t have time to explain it to you, nor is it my job. It’s complicated. But, look, I can have a slightly more comprehensible bill drawn up, which I can email to you if you give me your email address.”

“I never had any idea of any of this,” Brian said as he dashed off his email address and handed it over. “I’ll call Peerless as soon as I get home, and I’ll let you know what they say. There has to be a misunderstanding.”

“Fair enough,” Roger said. “And you’ll hear from me as soon as I can get the billing department to expand the bill however much is possible. But I warn you: It still isn’t going to be much more understandable than this one. As I told you, hospital prices are proprietary information.”

“I’ll take my chances.” He then added with mild sarcasm: “Thanks for your time.”

Leaving the administration area, Brian briefly debated whether to try to visit the ICU because he knew where it was on the second floor. He decided against it for two reasons. One was that it might upset the powers that be, and two, if Emma was still disoriented, she wouldn’t even remember he’d visited if he was able to pull it off. Instead, he used one of the courtesy phones in the main lobby and called to see if any of the ICU hospitalists were available, but had no luck.

Brian walked out of the hospital into a warm late summer day, which was beautiful weather-wise but totally lost on him. He walked out to Broadway and turned south as if he were in a trance. Not only was he terrified about the prospects of Emma’s condition, he was now discombobulated and mortified about the possibility that he was facing a horrendous bill he could not pay. All he could hope was that Peerless Health had made a mistake, one that could be rectified by a phone call. Yet from Roger Dalton’s comments, Brian wasn’t all that optimistic. He felt as if he were caught in the outer edges of a whirlpool that had the power to suck him under and drown him.

Chapter 7 August 20

The twenty-minute walk from the hospital to his house on West 217th Street was just long enough for Brian to recover, calm down considerably, and think. He had always been a doer who saw adversity as a challenge. By the time he’d turned onto his street, he was back to giving Peerless Health Insurance the benefit of the doubt. He was now progressively convinced that there had to be a major misunderstanding about the nature of Emma’s condition, and that a simple phone call to point it out would surely clear things up. With that issue possibly solved, he was able to think more about hospital prices and the incredible amount of money involved in healthcare. It seemed preposterous that it could cost more than twenty-seven thousand dollars for a single emergency visit, yet Roger Dalton obviously didn’t think it was at all exceptional. In fact, he had actually said it wasn’t out of line.

Back when Juliette had been born prematurely, Brian was vaguely aware of sky-high hospital bills, but that was for more than a month of neonatal intensive care. But even those bills hadn’t caused a fuss in his personal expenses, since his and Emma’s NYPD health benefits covered it in its entirety. Actually, as Brian turned onto his walkway, what bothered him the most at the moment was Dalton telling him that hospital costs varied depending on which health insurance company was involved and that he, as a nobody, had to pay “full freight.” He couldn’t imagine what people with no insurance at all had to do.

“What a crazy, screwed-up, unfair system,” Brian pondered aloud as he mounted the front steps of his house, one of the very few houses left standing among the myriad of apartment blocks of Inwood, Manhattan.

Once inside, the first thing Brian did was go into the kitchen, where he could hear a cartoon soundtrack. He found Juliette parked in front of the TV and Camila on her laptop at the kitchen table.

“How is everyone?” Brian asked, trying to sound chipper.

“Juliette isn’t hungry,” Camila said. “I’ve tried to tempt her with eggs and bacon, which she usually adores, but she doesn’t want any.”

“How about Bunny?” Brian asked Juliette. Bunny as per usual was tucked in next to her on the banquette. “Is she hungry for bacon and eggs?”

“Bunny has a headache,” Juliette said, without taking her eyes off the screen.

“I forgot about that,” Camila chimed in. “Juliette says she has a headache.”

“I’m sorry,” Brian said. “Maybe Bunny shouldn’t watch so much TV. Do you think that could be causing her headache?”

“I learned something interesting,” Camila said when it was apparent Juliette wasn’t going to respond. She took Brian aside, lowering her voice. “I researched whether young children can be depressed. Apparently, they can, but reactive anxiety is more common a problem. I think we are dealing with significant anxiety here with Miss Juliette.”

“That makes a lot of sense. Witnessing her mother having a seizure and then being kept in the hospital is certainly enough to cause anxiety. Hell, I’m experiencing it myself.”

“I guess we just have to be as supportive as we can,” Camila said. “At the moment it means letting her watch TV.”

“Agreed,” Brian said.

“So, what happened at the hospital? Any word on Emma’s condition?”

“No word on Emma. As for the hospital, they’re demanding to be paid out of pocket for Emma’s ED visit yesterday afternoon.”

“Wow! They don’t waste any time, do they?”

“And you won’t believe the amount they’re asking for,” Brian said. “It’s criminal. As for the speed, I got the sense that MMH Inwood is struggling financially with the coronavirus situation just like we are. Also, it seems the hospital has had a bad relationship with our particular health insurer. True to form, the company already denied the claim. But I’m hoping it’s a misunderstanding. I’ve got to call them and straighten it all out. Are you all right here with Juliette for now?”

“I’m fine,” Camila assured him. “Make your call, and good luck dealing with them. Last year I had a terrible time with my grandmother’s health insurance company.”

Back in the office, Brian searched in the upright file for the Peerless policy to get the policy number and the company’s phone number. When he found it, he noticed it was a Manhattan exchange and a Midtown Manhattan address. Sitting at his desk with the information in front of him, he placed the call. As it went through, he vaguely wondered how many of the Peerless employees were working from home and how many were actually going into the office, as it varied from company to company.

When the line was answered automatically, Brian had to listen to a long list of possible alternatives. He chose one of the last: customer service, which resulted in another extensive list of choices. Five minutes later, when he finally got to speak to a real person and explained that he was calling to contest a denial of claim, he was told that he had to speak to the claims adjustment supervisor on duty. Frustratingly enough, that required another wait of almost thirty minutes while Brian was forced to listen to insipid elevator music. As time passed, he struggled with rising impatience.

“This is Ebony Wilson,” a strong, compelling, yet mellifluous voice suddenly declared, breaking through the background music. “With whom do I have the pleasure of speaking?”

Brian gave his name and then explained why he was calling, namely to discuss the denial of a claim involving a visit to the MMH Inwood Emergency Department. He went on to say that there must have been a misunderstanding and that he wanted to clear up the situation.

“I’m sure I can help,” Ebony said graciously. “Can I please have your Peerless Health Insurance policy number?”

Brian gave the number, enunciating each letter and number so there would be no mistakes and he could get this done as quickly as possible.

“Just a moment, please,” Ebony said. In the next instant Brian found himself back to suffering through more background music. He knew that it was supposed to be calming, but under the circumstances it was having the opposite effect. Just when he was ready to figuratively scream, Ebony’s assertive and pleasant voice returned. “Okay, Mr. Murphy,” she said. “I have the claim here in front of me. It’s from Manhattan Memorial Hospital Inwood concerning an Emergency Department visit for Emma Murphy. Is this correct?”

“Yes, that’s it,” Brian said. In contrast to the elevator music, Ebony’s voice had a welcome and distinctive soothing quality. “Out of curiosity, are you in the Peerless Midtown office or are you working from home?”

“I’m in the office,” Ebony said. “As a supervisor, it works better for me to be here, same with senior management. Most of the secretaries work from home. Why do you ask?”

“No real reason, just curious. It’s such a crazy time, what with most people working from home if they can. I was wondering how the health insurance world was faring.”

“Okay, I have read through the adjuster’s report,” Ebony said, ignoring Brian’s comment. “Everything seems to be in order here. Why do you think there was a misunderstanding?”

“My wife had a grand mal seizure on the Henry Hudson Parkway after feeling ill all day,” Brian told her. “As soon as the seizure was over, we drove directly to the MMH Inwood Emergency Department.”

“Yes, that is documented here in the claim,” Ebony agreed. “But it also says that Emma Murphy walked into the ED without assistance at four-thirty and waited in line to be helped.”

“That may be true, but she was disoriented. I could have called for an ambulance, but that would have taken longer. When she had her seizure, we were in our car fifteen minutes away from the hospital.”

“I agree perfectly with your assessment, Mr. Murphy. An ambulance surely wasn’t needed and would have been an unnecessary expense. But so is the kneejerk reaction to go to a Trauma 1 Emergency Department when your wife should have been seen by her general practitioner, or perhaps an urgent-care center.”

“We don’t have a general practitioner,” Brian interjected. “My wife and I have been in perfect health. We work out every day. For our four-year-old we have a pediatrician, but we haven’t needed a GP.”

“Doesn’t your wife have a gynecologist?”

“Yes, of course she does, for her yearly checkup.”

“GYNs frequently function as general practitioners for young women. Your wife could have gone to her GYN, who could have seen her and admitted her to the hospital if necessary.”

“That’s absurd,” Brian practically shouted.

“Calm down, Mr. Murphy. Anger will get you nowhere. Let me explain something to you. Peerless Health Insurance and our CEO, Heather Williams, are responsible members of our community, our city, and our country. We provide health insurance coverage with the lowest-priced premiums possible, but it comes with responsibility on the part of our members. Let me ask you something, Mr. Murphy. Did you read your Peerless policy as carefully as was recommended by our agent?”

Brian glanced down at the thick stack of papers on his desk. The truth was that he had not read the policy at all and didn’t know if Emma had, either. He’d never read any of the health insurance policies he’d been given, even while an NYPD officer.

“I glanced at it,” he said, embarrassed to admit otherwise.

“Well, you should have read it carefully to know what you were buying,” Ebony said. “I recommend you go back and do so now. You see, to make our short-term policies affordable, we have made it a point to spell out specific limitations and define responsibilities of our members. Within our policy it is very clear what will be covered in the Emergency Department, particularly during normal business hours when urgent-care clinics and doctors’ offices are open. You see, we take our role seriously in trying to do something about the rise of healthcare costs in the United States.”

As Ebony droned on about the overuse of emergency medical facilities and the need to cut down healthcare costs in general, Brian’s mind suddenly harkened back to Roger Dalton and how right he’d been. But then Ebony got Brian’s attention by saying: “...but if you disagree with our adjuster’s decision, you have the right to request a review online.”

“I’m thinking I will do more than request a Peerless review,” Brian snapped. “Denying a legitimate claim like this seems criminal. I think this deserves a review by an attorney.”

“Of course, consulting an attorney and even initiating a lawsuit is your right,” Ebony said. “But, let me say this, attorneys are very expensive. And in my experience, which is rather extensive, as I do this day in and day out, you’ll be wasting your time and money. Peerless Health knows the ins and outs of this business extremely well, which is why we are so successful. We also have in-house counsel to deal with lawsuits. My advice, for what it is worth, is for you to request a Peerless review and see if it changes the situation. Occasionally it comes to light that an adjuster has made a mistake and the claim is reversed upon review. Is there anything else I can do for you today?”

Similar to how he’d felt after his conversation with Roger Dalton, it took Brian a few minutes to calm down enough to think clearly after disconnecting with Ebony Wilson. He was in no way a litigious person: far from it. As a committed law enforcement officer, he wasn’t fond of lawyers. And he recognized Ebony was probably right about the futility of hiring an attorney to try to deal with a company that undoubtedly was “lawyered up” and prepared to deal aggressively with any legal action. He was left with no other option than to request a review.

He brought up the Peerless Health Insurance website to log in, but before he did so, he decided to give the website some attention, seeing as it was basically his second time on there. After a quick glance at the section trying to sell policies to new customers, Brian clicked on the investment section. He learned that the company had had a wildly successful IPO two years ago and that the stock price had doubled since then, making it one of the fastest-growing companies on NASDAQ. It was immediately apparent that the entire success of the company was attributed exclusively to its wunderkind CEO, Heather Williams. Brian looked at the woman’s picture. He was impressed with her youth as a CEO of a public company — somewhere around thirty was his guess — and the intensity and imperiousness of her gaze.

Finding himself curious, Brian opened up a new page and looked up Heather Williams. He was surprised by the amount of material available on her and clicked on a recent biographical article. Now he was confronted with a second picture of the CEO that was starkly different from the typical businesslike head-and-shoulder pic on the Peerless website. This was a picture of a painting featuring a haughty Heather Williams in a foxhunting outfit with a horse on one side and a foxhound on the other. Brian’s immediate reaction was shock. In his mind foxhunting, like polo, was something reserved for English royalty or those people who aspired to be demonstratively aristocratic. His second reaction was to acknowledge that she’d probably had a very different and a much more privileged upbringing than he had. Beginning the article, he learned that she was the scion of a west Texas oil family, had gone to boarding school in England, and then graduated from Yale undergraduate and finally Harvard Business School.

“Good grief,” Brian exclaimed as he read on. She’d been hired by Peerless directly out of business school. At the time Peerless was a small company founded by a group of young entrepreneurs trying to break into the health insurance market by taking advantage of the passage of the Affordable Care Act and the subsidies it offered. Heather Williams quickly and cleverly saw a different path, and instead of relying on politically susceptible subsidies, she strenuously pushed the company to embrace the short-term health insurance market. Within just a few years, thanks to her aggressive and creative marketing, she was elevated to chief financial officer, or CFO, and two years later to chief executive officer, or CEO. In recognition of her single-handedly tripling the company’s stock value, she’d become a recognized and applauded darling of Wall Street.

After he finished the article, Brian returned to the picture of Williams in her foxhunting outfit. As he stared at it, he found himself wondering how much her and Peerless’s financial success were dependent on Peerless quickly denying claims, as had just happened to him. After entertaining the thought for a few minutes, Brian decided to move on and return to the Peerless website. He had more immediate concerns, like requesting a review of the claim denial for Emma’s ED visit, which he sincerely hoped would result in a reversal and possibly save his family’s fortune.

With that unpleasantness out of the way, Brian gave Camila a break from being with Juliette by spending almost an hour reading The House at Pooh Corner to his daughter in her bedroom. After finishing the fourth chapter, Brian looked up to discover Juliette had fallen asleep. Being as quiet as possible, he tiptoed out.

“How much information do you want on each of these guests for the potential Foster gig?” Camila asked as Brian came into the office and sat at his desk. She was at her desk on her computer.

“The more the merrier,” he said as he booted up his machine. He hoped that the Foster affair would take place despite the growing concern over a second wave of Covid. With that thought in mind, he went online to look at the Personal Protection LLC bank balances to figure out if there were adequate funds to somehow at least appease the hospital while Emma was an inpatient, especially in case Peerless wasn’t going to participate. As he expected, the balances weren’t encouraging, and they were going to be hard put to cover basic expenses and put food on the table if some significant business didn’t materialize during the next month.

“Our cash flow is a bad joke,” Brian voiced out loud. It was depressing, and for many reasons he wished he and Emma had not decided to take the vacation on Cape Cod even though they had gotten the cottage for a steal. Continuing in that trend of thought, he wished they had at least avoided the beach barbecue. Things could have been so different.

“As if I didn’t know,” Camila said. “We’re in dire need of some luck. Fingers crossed for this Foster event. One thing I’m going to insist on: Stop paying my salary until things turn around.”

“Camila, we couldn’t,” Brian countered and meant it.

“I know that neither you nor Emma have taken any salary for months. It’s only fair, especially since you’re giving me room and board.”

“At this point you are more like family,” Brian said. “How about we defer your salary? I’m willing to consider that under the circumstances.”

“That’s fine, if that’s what you want to call it,” Camila said.

With Camila’s suggestion of deferring, he looked back at the numbers. From that perspective it seemed possible that Brian could manage five to ten thousand dollars to placate the hospital, provided the bank was willing to continue deferring the mortgage payment on the house. With the mortgage question in mind, Brian decided to put in a call to their banker, Marvin Freeman. As the call went through, Brian thanked his lucky stars that he and Emma had not taken a business loan to start their security company and instead renegotiated the mortgage on their house. After the usual superficial pleasantries, Brian got right down to the reason for the call.

“Our business is suffering, as you might expect with this coronavirus situation.”

“You and a thousand other businesses.”

“What do you think the chances are that we could renegotiate our mortgage yet again to give us some operating cash to carry us through?”

“We just renegotiated your mortgage not even a year ago, Brian,” Marvin said. His voice lost some of its friendliness, becoming significantly more businesslike.

“I was afraid you’d say that,” Brian said. “What about a business line of credit? Something to get us cash if we get desperate.”

“What kind of collateral are you thinking of offering for a credit line?” Marvin asked. “Do you have any stocks and bonds?”

“No, we don’t have any collateral. The house is our only asset.”

“Having no collateral ties my hands, my friend. There’s no way I could get a line of credit for you without it. Plus, the bank is already allowing you to defer your mortgage payments for the immediate future.”

“Yes, and I appreciate that, Marvin. I suppose in a way that is already a line of credit.”

“You could look at it that way, but I should warn you that it is not going to last.”

“I understand, but thanks, Marvin.”

“Sorry I can’t be of more help.”

Disconnecting from the call, Brian went back to staring at the meager bank balances. After hearing the bank’s position, he really didn’t think he could pay MMH very much without putting himself, Emma and Juliette, and his fledgling business in jeopardy. Now more than ever, it seemed tragic to live in a wealthy country where basic emergency healthcare could put a decent, hardworking family like his at risk.

Chapter 8 August 27

Brian stepped out of his front door a little after eight in the morning, and as he put on his face mask, he surveyed the street in front of his house. The roadway was in the process of being repaved but so far had only been ground down and striated. It was a mess, dangerous to walk on, and he had no idea when it was going to be put back together. In many ways it seemed symbolic of his life in the past week.

Emma was still hospitalized after a week and not doing as well as Brian hoped. During her first twenty-four to forty-eight hours in the ICU, he had been told she’d improved and had regained a reasonable degree of orientation. But then when she was transferred into a normal hospital room and he was able to see her, he found her mental state varied from day to day. Sometimes she didn’t even seem to recognize him, and she spent most of her time sleeping. She had continued to run a fever, suggesting that the EEE virus was still active despite whatever antibodies her immune system was making.

But at least being in a normal hospital room made it possible for Brian to see her, and thanks to Camila, his mother, and Emma’s mother, he’d been able to spend considerable time doing so while the women took turns taking care of Juliette. His poor daughter missed her mother and was sulky, irritable, and withdrawn despite a lot of effort on the part of all three extra caretakers. To everyone’s concern, Juliette wasn’t even eating properly. Brian was enormously thankful that taking care of her wasn’t on his shoulders alone, as he wondered if he would find the patience it required. Just being with her during the night could be trying enough when she’d wake up crying.

Although he had taken one entire afternoon to run out to Southampton to check out the Fosters’ palatial summer home and meet the bride-to-be so that Camila could come up with a budget for the wedding, he spent every other day with Emma. It was his feeling that the nursing staff wasn’t spending the time necessary to make sure his wife was being appropriately mobilized. From his EMT training, Brian knew how important it was for a patient not to remain in bed continuously.

Multiple times every day, Brian forced her to get up and walk up and down the hallway despite her constant complaining. While walking with her two days before, he’d noticed a change in her stride. It was a kind of clumsiness that was almost imperceptible at first, but slowly progressed over the next twenty-four hours. Yesterday morning when he got her out of bed, it was definitely more apparent, and he brought it to the attention of Dr. Shirley Raymond, the hospitalist responsible for Emma’s care. She in turn alerted the neurology consult who had been following Emma. This new symptom, labeled by the doctors as spasticity, had raised Brian’s concerns, and as he started out toward MMH Inwood, he wondered if he would find Emma even worse today.

Feeling the need for exercise, which Brian wasn’t getting, he literally ran to the hospital. The face mask made it a bit more difficult, but he was willing to put up with it. As he entered through the front entrance into the marbled lobby, one of the women behind the information desk called his name. With as much time as he’d been spending at the hospital on a daily basis, he was becoming a known commodity.

“Mr. Murphy! Harriet Berenson would like to see you,” one of the pink-smocked ladies said.

“Who is Harriet Berenson?” he questioned. He was moderately out of breath, even though it had only been a little more than a week since he and Emma had done their daily mini-triathlons.

“She’s one of our discharge planners. Her office is on the second floor.”

Brian was taken aback. He never even knew there was such a position as a discharge planner. And why would a discharge planner want to talk with him — unless they were thinking of discharging Emma? But how could that be, particularly with her developing a new, alarming symptom? After hesitating for a moment to decide whether to go up to Emma’s floor first or visit Harriet Berenson, the latter won out. He needed to know sooner rather than later if there was even talk of Emma being discharged. The idea of having to take care of her at home terrified him.

“Ah, yes,” Harriet said once he had made it to her office. She picked up one of the folders on her desk and opened it. “Emma Murphy is to be discharged today. I want to arrange for post-hospital services.”

“My wife cannot be discharged,” Brian stated simply. As far as he was concerned, she was hardly capable of even basic functions. “That’s not going to work. Our house is ill-equipped to handle her needs. I’m not even sure she can climb a flight of stairs in her condition and the bedrooms are upstairs.”

“That’s good to know,” Harriet said. “That’s what I am here for: to make sure your wife gets the care she requires. We can certainly arrange for extended care in a nursing home.”

“But she’s developed some difficulty walking,” he argued. “And it’s getting worse.”

“Do you think a rehabilitation hospital would be a better solution?”

“I don’t know,” Brian stammered. “I hadn’t given it any thought. I certainly didn’t think she was ready to be discharged. She’s still symptomatic from the EEE virus. In fact, she still has a fever as far as I know.”

“That’s not what Dr. Kathrine Graham thinks,” Harriet countered. “She wrote the discharge order this morning.”

“Who is Dr. Graham?” Brian asked. He’d never heard the name.

“She is our Chief Medical Officer here.”

“Does Dr. Shirley Raymond know that my wife is to be discharged?” He had briefly seen Dr. Raymond around noon the day before, and she’d not mentioned anything.

“I’m sure she does,” Harriet said. “As I said, Dr. Graham is our CMO. If your wife needs help regaining strength for things like walking, a rehabilitation hospital would be the proper choice, no doubt. How does the Hudson Valley Rehabilitation Hospital sound to you? It’s in Hudson Heights, so it’s close by, and it is an excellent facility. We send a lot of our patients there.”

“I guess it sounds better than a nursing home,” Brian assented. A rehabilitation hospital sounded decent, but he was hardly enthusiastic.

“Okay, then I’ll get right on it,” Harriet said. “I know Hudson Valley has room because I placed someone there just yesterday. Now, I was told that you must see Roger Dalton right after talking with me. Do you know where his office is located?”

“I do.” He didn’t like the idea of seeing Roger Dalton again. He’d not spoken to the man since their less than personable visit a week ago and, from Brian’s perspective, it was better to let sleeping dogs lie in regard to the outstanding, humongous ED bill. Yet now that there was a possibility of Emma being discharged, it probably wasn’t avoidable.

Leaving Harriet’s office, he briefly debated whether to see Dalton first or check in on Emma. Reluctantly, he decided it best to get the Dalton meeting out of the way, as he might find it difficult to leave Emma if she became upset about being discharged. Using the stairs, Brian descended to the first floor and entered the administration area.

With Roger Dalton, Brian wasn’t so lucky as he’d been with Miss Berenson. Not only was there someone in the man’s office, but there was another individual waiting to see him, too. At least the wait gave him a chance to think about Emma’s discharge. He still did not like the idea, but he admitted he knew nothing about the Hudson Valley Rehab Hospital other than approximately where it was. Being that it was rehab hospital, maybe Emma would get more attention, but the uncertainty bothered him, as he didn’t know what to expect going forward.

When Brian finally walked into Dalton’s office and sat, he thought he was prepared for whatever the man was going to say, but he wasn’t, especially since the meeting started out on the wrong foot.

“I thought you were going to get back to me about the outstanding Emergency Department bill?” Roger said with a definite accusatory tone.

“I was planning on it,” Brian said in his defense. “I have applied for a review of the decision to deny the claim, and I’ve been waiting for a response.”

“You got your response,” Roger spat. “You were informed the claim again had been denied by email yesterday. I know because I’d resubmitted the claim when I hadn’t heard from you.”

For a brief moment Brian let his eyes drift away from Roger’s masked face as a minor flash of anger consumed him. He’d developed a distaste for this bureaucrat on their last meeting and his current holier-than-thou attitude was reminding him why.

“I suppose you are going to tell me you didn’t see the email,” Roger continued derogatorily.

After a short pause to control himself, Brian said: “You are correct. I have yet to see that particular email from Peerless. As it is, I’ve been busy trying to help my wife, who is not doing all that well. Is the ED bill the reason you asked to see me?”

“No, it is not,” Roger snapped.

“Well, perhaps you can tell me what it is then.”

“I’m afraid I have more bad news for you. When I was informed yesterday by our Chief Medical Officer that your wife was going to be discharged, I put together a preliminary hospital bill. Because we have had a history of such bad luck with Peerless Health, I wanted to get it to them ASAP. Well, my efforts were rewarded with Peerless informing us that they will not be covering any of the currently estimated $161,942.98 in-house bill, either.”

For a few moments of stunned silence, Brian’s mind tried to wrap itself around two incredible facts: the sheer size of the in-house hospital bill and the idea that a health insurance company would contend it wasn’t going to be involved with a sick patient’s required care. He didn’t know which was more outrageous.

“What am I supposed to gather from your silence, Mr. Murphy?” Roger demanded. “We have a major problem here. Frankly, we as an institution are finding it very difficult dealing with these short-term insurance policy companies, especially since they have proliferated during this coronavirus pandemic with people losing their employer-based coverage.”

“More than one hundred and sixty thousand dollars is a big bill,” Brian managed to say, thinking out loud as he tried to conceive of such a number.

“It is not an exceptional hospital bill by any stretch of the imagination in this day and age,” Roger said. “Remember, your wife spent several days in the intensive care unit, which, like the Emergency Department, is very expensive to maintain and run. And she has had many tests over the eight days, including several MRIs and a number of electroencephalograms.”

“I suppose,” Brian said distractedly. Once again, his mind was going a mile a minute, trying to put this cost into the perspective of his life experiences. The only time he’d dealt with such a number was when he and Emma had bought their house. But that was an investment, not a one-time expense, and his wife was still ill.

“Mr. Murphy, please,” Roger said. “This is a major problem, and I need your full attention. We have to decide on a course of action.”

“Did Peerless give a reason why they wouldn’t be covering any of the hospital bill?”

“Yes, they did,” Roger said. “I was told it had to do with your deductible, all of which was spelled out clearly in your policy. Did you read your policy, Mr. Murphy?”

“Not carefully,” Brian admitted, fully aware that he was fibbing similar to the way he’d done during his conversation with Ebony Wilson.

“Well, it sounds like that was a big mistake,” Roger said patronizingly.

With some difficulty Brian resisted the temptation to ask Roger how many novel-length, legalese-strewn health insurance policies he’d read in his lifetime.

“I know my policy had a ten-thousand-dollar deductible. Doesn’t that mean the insurance company is then supposed to cover the rest?”

“All policies are different,” Roger said. “It’s up to you to find out. Meanwhile, what do you propose to do about the now $189,375.86 bill that is owed to MMH Inwood? We need to know, or we will have to turn this over to collections.”

“I intend to resolve this situation with Peerless today,” Brian insisted. “And I’m not going to try to do it over the phone. This sort of money calls for an in-person visit.”

“All right, that’s up to you,” Roger said. “But you must get back to me soon. You can’t ignore this situation.”

“I’ll get back to you right away, but before I go, I need to ask something. What came first: the decision to discharge my wife or the hospital getting word from Peerless that they were not going to cover the bill?”

“I don’t think I understand the question.” Roger sat back in his chair, wrinkled his forehead, and stared at Brian through his thick-framed glasses.

“I can’t help but worry that the reason my wife is being suddenly discharged is because of the outstanding ED bill along with the new fear that her hospital bill might not get paid in a timely manner.”

“That is a preposterous accusation,” Roger said, taking immediate offense. He rocked forward, glaring at Brian. “The clinical people, meaning the doctors and nurses, make all the decisions about patient care. We on the business side are not involved, ever! All we do is strive to keep the institution solvent. The two do not mix on any level whatsoever.”

“Really?” Brian questioned. “There had been no talk of her being discharged as far as I know, and I’ve made it a point to talk daily with Dr. Raymond, who’s been in charge of her care. This all seems very quick and out of the blue. And my wife has recently developed a new symptom of spasticity. From my vantage point, she’s no better off now than when she was admitted.”

“Let me tell you something, young man,” Roger said as he used a mildly crooked index finger to point repeatedly at Brian. “This hospital never allows financial concerns to affect patient care decisions. Never! I’m offended you would even suggest such a thing.”

“I wonder,” Brian questioned while provocatively raising his eyebrows. He was getting a smidgen of pleasure from being the cause of Roger’s apparent indignation and discomfort. After a pregnant pause, he added: “Who actually is Dr. Graham, this supposed chief medical officer? I’ve never met her, and I have been coming here every day for more than a week to see my wife. Is she more on the clinical side or the administrative side?”

“What on earth do you mean?”

“What I’m wondering is whether she is more concerned about patient welfare or institutional welfare. It’s as simple as that.”

“Dr. Graham is part of the administration, but she is also a doctor,” Roger sputtered. “Once you are a doctor, you are always a doctor. That should be plenty obvious.”

“I hope you’re right,” Brian said. He stood up, knowing that the chances of getting a straight answer were slim. “Meanwhile, I expect to get a copy of the hospital bill, and I’d like it in English. Even the second ED bill you sent me seemed like it was done on an Enigma machine.”

“I’ll see what I can do,” Roger said. “But let me warn you in advance: The hospital bill will definitely be more complicated than the ED bill, especially the part involving the ICU. And the bill from MMH Inwood is not the only bill you will be getting. You’ll also get bills from individual doctors not employed by MMH who saw your wife during her stay.”

“What kinds of doctors?” Brian demanded as he sat back down. This sounded like insult added to injury or, more accurately, like a kind of extortion.

“Specialists of various kinds,” Roger answered vaguely. “Some of the consults are independent practitioners.”

“Is this the surprise medical billing I’ve vaguely heard about?”

“It is,” Roger admitted.

“Well, get me what you can,” Brian said while regaining his feet in preparation of leaving. “Meanwhile, I’ll be back to you after I have a face-to-face visit with Peerless Health, which will hopefully be today.”

As he rode up in the elevator, he couldn’t get the concern out of his mind that Emma was being discharged on account of economics, which was an infuriating thought. When he walked into Emma’s room, he found her asleep, which was happening more frequently of late. Instead of waking her, he let her be and returned to the nurses’ station. Over the preceding week he’d gotten to know many of the day-shift nurses, including the charge nurse, Maureen O’Hara, whose brother Brian knew well. They’d shared a class in grammar school and had attended the NYPD Academy together.

“So, Emma is being discharged,” Brian said when he managed to get Maureen’s attention. She was a no-nonsense, squat, and powerfully built woman just like her brother, and she ran the fourth floor with an iron fist. She, like most of the floor nurses, was wearing a plastic face shield as well as a mask.

“That’s what I’ve been told,” Maureen said. “To tell you the truth, it took me by surprise.”

“Do you think it’s appropriate?”

Maureen shrugged. “We’re not doing all that much for her. In fact, you are doing more than we are, even more than physical therapy. The thing that I am most concerned about is the seizure monitoring.”

“Me, too,” he said. “What’s the story with this Dr. Kathrine Graham?”

“What exactly do you mean?”

“I’m not sure. I was just told she was the one who wrote the discharge order.”

“That’s not surprising,” Maureen said. “She does that a lot.”

“What kind of doctor is she?” Brian asked. “I’ve never met her.”

“She doesn’t often come to the floor. She has an office in admin. My understanding is that she was an internist before becoming the Chief Medical Officer.”

“What about Dr. Raymond? Where is she today?”

“She’s back in the chart room. I saw her go in there not five minutes ago.”

Knowing full well he was overstepping his bounds to a degree, Brian went to the door to the chart room and pushed it open. Instead of being full of charts as he was expecting, the room was made up of countertops and computer monitors. Dr. Raymond and several other people were busy entering data. The only noise was coming from the keypads.

“Excuse me, Dr. Raymond,” he called out self-consciously. “Could I please have a word?”

To Brian’s relief, she immediately stood up and came to the door. Speaking in a whisper, she asked what he needed.

“I’ve just heard my wife is being discharged,” Brian whispered back.

Dr. Raymond graciously stepped out of the chart room, allowing the door to close.

In contrast to Maureen, Dr. Shirley Raymond was rail thin and imbued with a nervous energy. “Yes,” she said. “I was informed of the discharge plans this morning.”

“So, this wasn’t your decision?” Brian was surprised to learn that she hadn’t been involved in the order.

“No, it wasn’t. It’s apparent to me that Emma still has an active viral infection. She also seems to be somewhat drowsier and more confused. And, as far as I know, neurology hasn’t finished evaluating the spasticity that’s emerged.”

“The current plan is to send her to Hudson Valley Rehabilitation Hospital.”

“Oh, I didn’t hear that,” Dr. Raymond said. She shrugged. “That will work, I guess. She should be under a seizure watch since the encephalitis is still obviously active, and they’re capable of doing that at Hudson Valley. Although, if it were up to me, I’d keep her here in an acute care facility.”

“I was told she was discharged by a Dr. Graham. Do you know her?”

“Of course. She’s one of the kingpins around here.”

“Is she a good doctor?”

Dr. Raymond laughed nervously. “That’s a strange question. Yes, I guess she is a good doctor.”

“To be frank, I’m a little worried. Do you think there is any chance that finances influenced the decision to discharge my wife?”

She shook her head. “No. That’s not how we practice medicine. There must be a valid reason Dr. Graham gave the discharge order. Perhaps it’s to free up beds for the expected Covid-19 surge.”

“That’s reassuring coming from you. Well, thank you for talking with me and thank you for taking care of Emma.”

“You’re very welcome. And good luck. I’m afraid you are in for a long haul with Emma. EEE is a persistent illness.”

“Yes, I’ve gotten that impression,” Brian muttered and turned to return to Emma’s room, significantly more confused and daunted by these conversations than he was expecting.

Chapter 9 August 27

It was just after two in the afternoon when Brian walked out of the Hudson Valley Rehabilitation Hospital and paused on the steps to regroup. He was feeling out of sorts. It had been a stressful morning. Emma had resisted the idea of leaving MMH Inwood, but there had been little he could do, and it was true to an extent that MMH wasn’t doing very much in terms of therapy. It was also true that Emma had not had another seizure since the one in the Emergency Department, so maybe the need for seizure monitoring was less important. Plus, the term “rehabilitation” had a nice ring to it as far as Brian was concerned, and he hoped that there would be more opportunity for Emma’s walking difficulties to be addressed. But that was before he had seen the hospital.

During the admission process, Brian again had to sign papers giving the name of their insurance carrier and committing to being responsible for all charges. Knowing what he did about Peerless, it was obvious he was accepting even more debt despite having no possible way to come up with the money he already owed.

And if all this wasn’t bad enough, Hudson Valley Rehabilitation Hospital had been a disappointment. In sharp contrast to the renovated MMH Inwood, the building was aged and shabby, especially Emma’s room. And worse still, the number of patients per nurse was significantly higher than at MMH, meaning Emma probably wasn’t going to be receiving a lot of seizure monitoring or monitoring in general. Luckily she seemed oblivious to the nature of the hospital surroundings and had fallen into a deep sleep almost immediately after she’d been put in her bed and her vital signs were taken. The transfer procedure had been stressful for her even though MMH had arranged an ambulance service, and she had been moved in and out of both institutions on a gurney. The ambulance ride itself had been only fifteen or twenty minutes, and Brian had been able to ride with her.

From his perspective, this whole experience of Emma contracting a disease that he had never heard of from an innocent barbecue had been a rude awakening. As a conscientious hard worker who followed the rules, he’d always felt reasonably in control. Now it was the exact opposite. It was as if he and Emma had been poised on a precipice and didn’t know it, and now that Emma had slipped off, Brian and his family were only holding on by their fingertips. To make matters worse, he’d never had any inkling that the cost of a week’s stay in a hospital could potentially upend his life thanks to an unscrupulous health insurance company. It seemed criminal that he was now almost two hundred thousand dollars in debt and counting.

Pulling his phone out of his pocket, Brian made a quick call to Aimée to let her know that Emma had been moved and to ask her to let Emma’s mother know as well. He then passed along the current visiting restrictions and requirements. Toward the end of the call, he experienced a sudden and unexpected surge of emotion, bringing him almost to tears.

“Are you okay, Brian?” Aimée asked, detecting a catch in his voice.

“This is all more stressful than I could have imagined,” Brian managed after a pause. He’d not shared any of the financial problems with his mother, nor his worry that Emma might have been discharged from MMH because of the bill. “I hope this Hudson Valley Rehab Hospital works out.”

“I’m sure it will,” Aimée assured him. “I’ve had a number of friends who have been hospitalized at HVR, and they did well. It’s not the Ritz or even MMH, but the staff is friendly and caring.”

“They better be, or there’s going to be hell to pay.” As quickly as his surge of emotion had appeared, it metamorphosed into anger, and he was reminded of his planned visit to the Peerless Health Insurance offices. “Mom, I’m sorry, I’ve got to go.”

“Okay, dear,” Aimée said. “I’ll let Hannah know that Emma is situated at HVR, and we’ll plan out a visiting schedule. You get home and take care of that darling daughter of yours. She needs your attention, too.”

Brian disconnected the call, eager to make the visit to Peerless. The question was: How to get there? With his anger ramped up and wanting to get it over with quickly, he decided on the subway. From Inwood it was by far the fastest way to get to Midtown Manhattan.

Ten minutes later he was on the A train thundering south, and as he rode, he thought about the hospital bill that Roger Dalton had emailed to him and that he’d glanced at briefly on his phone while waiting for Emma to be discharged. As Roger had suggested, it was mostly incomprehensible and in code similar to the ED bill, but there were some bits of it that were perfectly understandable and that riled Brian to no end. One of those was an outlandish charge of $970 for a supposed “physical therapy evaluation session.”

From the date of the service, Brian distinctly remembered the episode. A young, bouncy, and very friendly woman had appeared at Emma’s bedside, gotten her out of bed, and proceeded to merely walk her up the corridor exactly as he had done fifteen minutes earlier. Another was a thirty-dollar charge for a single ibuprofen tablet that Brian had requested for Emma on that same day when she complained of a headache. From Brian’s perspective, if such charges were representative of the entire bill, the whole thing bordered on being absurd, if not out-and-out fraud.

From the Columbus Circle express stop it was a relatively short walk to the building on Sixth Avenue where Peerless Health Insurance had their home office. He found it strange to be walking the streets of Midtown Manhattan and seeing so few people. Like on the subway, most of the few people he encountered were masked. Reaching the proper building, Brian thought it a coincidence that it happened to be a few doors down from where Priority Capital was located. Thinking about Priority Capital and Calvin Foster made Brian hope that his proposed budget for the fancy Southampton wedding was being well received, and that he could be on the verge of securing some income.

He had purposely not called ahead to schedule a meeting with Peerless, as he doubted that they would be willing to see him. These days, companies limited physical contact, often preferring phone or, better yet, impersonal email exchanges. Dealing with an unhappy customer like Brian was far easier at a distance, particularly online. Of course, there was still the problem about physically accessing the Peerless Health Insurance office with the security Manhattan commercial office buildings invariably employed. But Brian still had his duplicate NYPD shield and ID. The fact that his ID card had retired under the photo hardly limited its effectiveness in providing access to most everything in the city. Besides, he also knew that many of the NYC commercial office buildings employed retired NYPD officers as guards.

As he negotiated the revolving door, he withdrew his wallet to have it ready. Similar to the street outside, the interior of the building was almost deserted. As he approached the security desk, he was encouraged to see, seated behind a plastic shield, a well-groomed, silver-haired, mildly overweight gentleman who looked the part of a retired cop with his crew cut and mustache. With practiced nonchalance, Brian flashed his ID quickly and the two men exchanged a convivial, knowing greeting, like members of a private club.

“How are you, my friend?” Brian said.

“Fine, thank you,” the security man replied with a broad smile. “Are you with Midtown North Precinct?”

“No, ESU.”

“Oh, wow!” the guard said. The ESU was highly regarded by the entire NYPD, since they were the ones called in whenever the regular patrolmen confronted a major problem. “How can I help?”

“How about yourself? What was your last command?”

“I retired from Midtown North. It’s how I got this job.”

“Good for you, but it looks like you’re not very busy these days.”

The security guard laughed. “It’s unbelievable,” he said. “It’s like a morgue around here. It makes me wonder if it’s ever going to go back to normal. So, what can I do for you?”

“I need to talk to someone at the Peerless Health Insurance office,” Brian said. “Are many of them here or are they all working from home?”

“A few of them come in. Mostly the brass. None of the secretaries or grunts.”

“How about Ebony Wilson?” he asked. “Do you know her, by any chance?”

“Of course I know Ebony. She’s one of the ones who comes in every day. Treats me like a person, and always says hello. Not like the Peerless boss lady.”

“Are you talking about Heather Williams?” The eccentric and rather outlandish image of the woman in the pretentious foxhunting outfit popped into his mind.

“I don’t know her name,” the guard said. “I made a point of not wanting to know it.”

“Why is that?”

The guard looked to both sides as if to be sure no one was listening, even though the expansive lobby was otherwise deserted. A janitor who’d been wiping down the turnstiles with disinfectant when Brian had first entered had disappeared. “She’s extremely snotty and thinks she’s better than everyone else. That’s my personal assessment. Not only does she not say hello, but she doesn’t even acknowledge that I exist. She waltzes through here with her entourage like she’s the pope.”

“What do you mean, ‘entourage’?”

“She’s always surrounded by three or four people rushing around her doing this and doing that, fawning over her. It’s ridiculous. She doesn’t even push her own elevator button. And several of them are armed bodyguards. I know because I had a conversation once with one of them. He’s a former marine.”

“Armed guards? That’s rather surprising,” Brian observed. “But are you sure about that? Don’t you think maybe this former marine was pulling your leg?”

“I swear on a stack of Bibles,” the guard promised. “I’m not exaggerating.”

“But why?” It seemed excessive, to say the very least.

“The ex-marine I spoke to says she’s become really wealthy. He bragged she’s been making ten million a year.”

“That can’t be true.” The idea that the CEO of a small, up-and-coming health insurance company could make that kind of salary seemed ridiculous.

“It’s not out of line,” the guard insisted. “As a small-time investor, I happen to know that some of the CEOs of the big health insurance companies that I’ve invested in make upward of twenty million a year.”

“Really?” Brian questioned. He never knew that such salaries existed in healthcare, though Emma’s astronomical hospital bills were beginning to make more sense. Someone had to benefit.

“It’s true. Health insurance companies are good investments. Mark my words.”

“I’ll give that some thought,” Brian replied for lack of another response. He wondered if the security guard was exaggerating. Twenty million for running a company that sold health insurance seemed preposterous.

“You learn a lot being one of the security guards in a building of this size,” the guard added.

“I bet you do. How about today? Did you see Ebony Wilson?”

“Oh yeah,” the guard said. “She’s upstairs.”

“Well, she’s one of the people I need to talk to.”

“Is she in trouble?”

“No, no,” Brian said quickly. “I just need to chat with her about Peerless. What floor?”

“Fifty-fourth. Do you want me to call up there and let her know to expect you?”

“I’d rather you didn’t. You know the trick. It’s often better to catch certain people unawares, because you might learn more.”

“Gotcha.” The guard gave him a knowing look and a thumbs-up. “Use the turnstile farthest to the left.”

“Will do,” Brian said as a youthful, casually dressed man in jeans, polo shirt, and tennis sneakers entered through the revolving door. As he passed, he flashed a card at the security guard and headed for the turnstiles.

“Hello, Mr. Bennet,” the guard called out. Then to Brian he whispered: “He’s with Peerless.”

“Now, that might be handy,” Brian said, making a rapid decision. Quickly he headed for the visitors’ turnstile and pushed through. Hurrying after Mr. Bennet, who had boarded one of the elevators that served floors forty through sixty, he was able to catch the elevator door before it closed.

“Sorry about that,” Brian apologized as he stepped in.

“Not a problem,” Mr. Bennet replied graciously.

“The guard happened to mention that you are with Peerless Health,” Brian said, making it sound like a casual statement.

“I am indeed,” Mr. Bennet agreed. “Director of sales. And you?”

“I run a security firm,” Brian said. “I’m impressed, and I hope you don’t find this offensive, but you look more like a college student than a health company executive.”

“I’ll take that as a compliment,” Mr. Bennet replied with a laugh, tossing a bit of his blond hair out of his eyes.

“I’ve heard that Peerless is doing very well.”

“You heard correctly.”

“So, you think the stock is a good investment?”

“It’s an excellent investment,” Mr. Bennet said. “Especially with the coronavirus pandemic, we’re selling short-term health policies like no tomorrow. I’d certainly advise you to pick up some stock if you are in the market.”

“Maybe I will,” Brian said, nodding his head. “Thanks for the tip.”

“You’re very welcome.”

The elevator came to a stop on the fifty-fourth floor and Mr. Bennet got off. Brian followed right behind. With an entry card, the man unlocked the door into the Peerless suite. A moment later they were standing in front of an empty reception desk in a posh lobby furnished with high-end leather furniture and with a view to the west over Sixth Avenue that included a tiny wedge of the Hudson River. But by far the most dominant object in view was the near life-size painting of Heather Williams dressed in her foxhunting finery.

“Excuse me,” Mr. Bennet said, turning to face Brian. “Who are you here to see, if I may ask?”

“Ebony Wilson,” Brian answered distractedly. It was hard to take his eyes off the painting, especially remembering the security guard’s impression of her personality and narcissism.

“Is she expecting you?”

“Absolutely,” Brian assured him. “Can you tell me where her office is?”

“Of course. Follow me!”

After skirting a number of empty secretarial desks, Mr. Bennet stopped at an open door and leaned in. “Ebony, there’s someone here to see you.”

“Who is it?” Brian could hear her ask.

Mr. Bennet turned to Brian, raising his eyebrows questioningly.

“Brian Murphy,” Brian declared as he advanced to the doorway and looked in. In sharp contrast to Roger Dalton, whose deep baritone voice belied his appearance, Ebony Wilson and her assertive voice were well matched. She was an athletic-looking African American woman with a smattering of freckles over her face. Her dark hair was done in a braid, and she was sitting behind a monitor.

“Nice chatting with you, Mr. Murphy,” Mr. Bennet called out before continuing on to his office down the corridor.

“Likewise,” Brian called after him.

Ebony leaned back in her chair and removed wireless earbuds she used for her phone conversations as a claims adjustment supervisor. She tilted her head to the side as she gave him a studied look. “Brian Murphy?” she questioned. “Do I know you?”

“Somewhat,” Brian said vaguely. He stepped into the small office and sat down uninvited in one of two side chairs. “We spoke on the phone about a week ago.”

“I speak to people all day every day. You’ll have to be more specific. Are you an employee of Peerless?”

Brian laughed mockingly. “No, I’m not an employee of Peerless, and we certainly have never met. We spoke about Peerless denying a claim for an Emergency Department visit at MMH Inwood for my wife. You advised me to request a review, which I did, and which has again been denied. But that’s not why I am here.”

“How on earth did you get in?” she demanded as she straightened up in her chair.

“I walked in,” he said.

“I don’t mean how you physically got in. I mean how did you get past security and into our office suite?”

“Mr. Bennet was nice enough to get me in the office,” Brian said. “As far as building security was concerned, all I did was show the guard my NYPD ID. Would you like to see it?” Brian leaned forward to allow him to get out his wallet.

“No, I suppose not since you are already here. Okay, so you are a Peerless customer. If you are not here about a claim denial, why exactly are you here?”

“I didn’t say it wasn’t about a claim denial,” he corrected her. “In fact, it is. It’s just not about the Emergency Department claim we spoke about. It’s now the inpatient hospital bill that I’m concerned about. I’ve been told today that Peerless will not be covering that either, and I want to know why. This situation is the reason my wife and I made sure we had health insurance: in case one of us had to go to the hospital.”

“Maybe you better show me your NYPD ID,” Ebony said. “None of this makes sense.”

Brian complied, flashing the ID the way he’d done for the security guard, but she wasn’t to be fooled, and she demanded to see it up close.

“I see. So you are retired,” she said, handing it back. “You hardly look old enough to retire.”

‘‘My wife and I started a security company,” Brian explained. “She was also an NYPD officer.”

“Which I assume is the reason you purchased a Peerless policy.”

“That’s correct. We were trying to be responsible because we couldn’t afford the COBRA premiums that would have allowed us to stay covered by the NYPD health insurance.”

“Do you have your Peerless policy number with you?”

“I do,” he said, and he gave it to her. She used her computer to bring up the record. As she read, Brian glanced around at the surroundings. Even this small office was opulently decorated, making him wonder what kind of sumptuous, over-the-top quarters Heather Williams occupied. It also made him wonder how such extravagance could be supported by the mere two-hundred-dollars-a-month premium he and Emma had been paying. But then he remembered that when they had bought the policy in December, they’d been told such policies like theirs were selling like hotcakes because a huge number of self-employed people couldn’t afford standard health policies that commercial businesses were buying for their employees. And that was before some twelve million Americans lost their jobs and their employer-based health insurance during the pandemic. Even if just a million of those people bought Peerless policies, that could mean $200 million a month revenue for the company.

“Okay, I found your case and have read through the latest adjuster’s decision. It’s actually pretty simple. Did you carefully read your policy like I suggested during our phone call about the Emergency Department bill? I remember you said you hadn’t when you purchased it.”

“No, I haven’t,” Brian admitted. “My wife’s illness has taken precedence since we talked.”

“Okay, tell me this. Are you aware your policy has a sizable deductible?”

“Of course,” he said. “The sales agent let us know that it was ten thousand dollars.”

“How about the amount that Peerless would pay per day for hospitalization?”

“I’m not sure I remember that.”

“It clearly states in your policy on page thirteen that Peerless will pay a thousand dollars a day after the deductible is satisfied.”

Brian suddenly felt embarrassed, realizing what fools he and Emma had been. Although a thousand dollars a day had sounded like a lot of money when they bought the policy, Emma’s stay in MMH Inwood had been well over twenty thousand dollars a day.

“So now let’s talk about the deductible,” Ebony continued. “Are you aware how the Peerless deductible works?”

“I assume so,” Brian said. “It means that we are responsible for the first ten thousand dollars. After that, Peerless steps in.”

“No, that’s not how the Peerless short-term policy deductible works. This is why you should have carefully read your policy, Mr. Murphy. With Peerless Health Insurance the deductible relates to Peerless payments, not to the policy holder’s payments.”

“I don’t follow,” he said, confused by all the semantics.

“Peerless doesn’t pay the thousand dollars a day until it would have paid ten thousand if there was no deductible. Essentially that means the hospitalization has to be for more than ten days. Starting on the eleventh day, Peerless pays a thousand dollars a day. It is a permutation of the deductible concept devised by Heather Williams, our esteemed CEO, when she was our chief financial officer.”

“But that’s totally crazy,” Brian managed. “That’s the opposite of what everyone understands about a deductible.”

“Excuse me, but it is very clearly explained in the policy. It’s the reason you were advised to read it carefully. All our salespeople make a big point of making sure our customers understand their policies. And it is all spelled out in our extensive promotional materials, which I’m certain you were given.”

“Maybe it was described,” Brian admitted, yet he still felt cheated and incensed. Actually, he barely remembered how he and Emma had ended up with their Peerless Health Insurance in the first place. Was he the one who had found it or had it been Emma? He didn’t know. All he could recall was talking with her about the need to have something for the rare “just-in-case” possibility and that they needed to look into the short-term policies the government was pushing. In many ways they were between a rock and a hard place thanks to a screwy healthcare system dependent on corporate or government employment.

“Is there anything else I can help you with?” Ebony asked. He could tell she was at the end of her patience with his unexpected appearance. “I really have to get back to work, and I have at least a dozen people on hold.”

“I have a few more questions,” Brian demanded, his rising anger causing him to flush. “I’m staring at a nearly hundred-and-ninety-thousand-dollar bill and counting, which boggles my mind. I had no idea hospitalization was so expensive. But you and your friends here certainly knew since you’re in the damn healthcare business. Here’s my question: Above and beyond the screwy deductible business, how the hell can you people possibly justify selling a policy that’s going to bankrupt a family by only paying a thousand dollars a day? I mean, in contrast to all of us common folk with limited experience with hospitals, all of you insurance types surely know that a thousand dollars a day for hospital costs is equivalent to pissing on a forest fire.”

“Just a minute, Mr. Murphy!” she stammered with obvious indignation. “I’m not going to sit here and allow you to verbally abuse me.”

“Maybe I should be complaining to someone higher up,” Brian said, reining in his anger by recognizing he was talking with a mere functionary. “I apologize for singling you out. But try to understand my situation. I’m facing financial ruin, and maybe the details of my insurance coverage were spelled out in the small print, but as a member of the general public, this seems to amount to a type of fraud. Maybe I should file a complaint of unfair and deceptive business practices with something like the Better Business Bureau.”

“Filing a complaint or even instigating a legal action is your right, as I told you a week ago on the phone,” Ebony said, partially mollified by his apology and the change of his tone. “But, as I also told you, the chances of anything like that going anywhere positive are just about zero. We here at Peerless are filling a needed niche, as the government has encouraged us to do, at the lowest possible price. Anyone can get health insurance that pays a higher portion, if not all of hospital costs, but insurance is like anything else: You get what you pay for.”

“What about arranging for me to have a talk with this esteemed CEO of yours? She’s the one who needs to have an idea of what she is doing to real people buying her policies.”

Ebony’s jaw dropped open in mock shock. “Now, that would be an interesting confrontation,” she choked out. “Let me tell you something: Heather Williams is riding the crest of a wave and doesn’t talk to mere mortals. I’m doing well with this job and I’m appreciated, but there is no way that even I could arrange to have a meeting with her. Even high-flying investment types often have to pay for her time.”

“She sounds charming,” Brian said sardonically, also remembering the security guard’s description.

“She’s a piece of work, no doubt about it. But she is extraordinarily good at what she does. I have to say we are all appreciative of the ride she’s engineered for us, especially with the employee stock she’s doled out to encourage company patriotism.”

Fifteen minutes later and more irritated and strung out than he ever remembered feeling, Brian left Ebony’s office. He felt as if he’d accomplished nothing. Reaching the empty Peerless lobby with its vacant reception desk, he collapsed onto one of the leather couches, wondering how much of the expensive piece of furniture his and Emma’s premiums had paid for. Adding insult to injury, he found himself staring again at the haughty foxhunting portrait.

A sudden clamor of voices at the far end of the long hallway caught his attention. A few moments later a throng of five people entered the room, heading for the door out to the elevators. Leading the pack was none other than the woman in the painting herself, perhaps having aged maybe five or ten years. In Brian’s estimation, she appeared to be maybe a year or two younger than Emma’s thirty-four. As she swept past with a determined, rapid gait, she glanced in his direction. For a moment a look of mild disdainful bewilderment flashed across her thin-lipped, carefully made-up face, but she didn’t slow down.

“Excuse me! Heather Williams?” Brian called out on a whim. “I need to talk to you. I think you’re in need of some moral advice.” His unplanned outburst surprised even himself, but it had the desired effect. The Peerless CEO came to a stop at the threshold of the lobby door that had been opened for her. She turned to treat Brian to a shocked but clearly contemptuous inspection.

“You are going to give me advice?” she questioned with a disbelieving tone. “Who the hell are you?” Her voice was shrill. She was obviously unaccustomed to being accosted by a stranger, especially in her own office. “Do you know it costs a thousand dollars a minute to talk with me?”

“That sounds like a bargain to me,” he said as he leaped to his feet. He wanted to take full advantage of this serendipitous encounter by looking at her eye to eye. “I was guessing more like two or three thousand at the very least.”

In spite of her obvious irritation, Heather laughed. Apparently, Brian’s mocking humor appealed to her narcissism. From the vantage point of his six-foot-one stature, he guessed she was somewhere around Emma’s five-eight but of much slighter build. What he didn’t expect was that his sudden standing up alarmed two of the four men in her entourage, including the one who had rushed ahead to open the lobby door. Both of these men were dressed in dark, ill-fitting suits and wearing prototypical aviator sunglasses. Instantly it occurred to Brian that the two older men were the bodyguards the building security guard had described.

As the two men started toward him, reaching under their lapels presumably for their firearms, Brian instinctively went for the P365 Sig Sauer nine-millimeter automatic pistol holstered in his waistband, which he carried religiously ever since he’d been a cop. Brian was a firearms expert par excellence, particularly with a handgun, which he had trained with on a regular basis and was fully licensed to carry. Luckily, in this instance, a potentially bad situation was averted by Heather, who snapped her hands out laterally to restrain her overeager escorts. Brian relaxed the fingers wrapped around his gun’s grip.

“I repeat: Who are you?” Heather demanded. “And what makes you possibly think you can give me advice?”

“I’m a very, very dissatisfied Peerless Health Insurance customer,” Brian answered. And then while poking his index finger accusatorily toward Heather’s face, he added: “You should be ashamed of yourself for designing and selling your worthless policies.”

Reacting to Brian’s possibly threatening hand gesture, the two bodyguards surged forward once more only to have Heather restrain them for the second time. There was little doubt that in his angered state he could more than handle these two mildly overweight, out-of-shape men who looked more like bouncers at a small-town bar than proper security personnel. In his aggravation, he would have actually enjoyed giving in to his bottled-up emotions and taking them down.

“Worthless?” Heather questioned in an overly mocking tone. “I beg your pardon, but thousands of extremely happy investors would tell you how wrong you are. How in God’s name did you get in here, anyway?”

“You’re the second person who has asked me that question,” Brian said, imitating Heather’s sarcastic tone. “I merely walked in, which means that not only are you selling morally suspect crap, it seems that you are in dire need of some professional security advice. Luckily, I happen to be an expert in that realm, and I’d be happy to give you one of my cards if you are interested.”

“Get the hell out of here!” Heather snapped, pointing to the door to the elevator lobby. “And if you ever venture to come within a hundred yards of me again, I won’t restrain my pit bulls.”

Despite himself, Brian laughed while glancing briefly at the two supposed pit bulls. “I hope that’s a promise, not a warning. But I can tell when I’m not appreciated, so I’ll take your suggestion and leave. But, your threat notwithstanding, I have a sense that you are going to hear from me again very soon. You, your attitude, and your company continue to ruin my life. It’s just not right, and I’m going to do something about it.”

Without looking back, he walked to the door, deriving a bit of satisfaction from the shocked silence his little speech had engendered. Unfortunately, when he got there, he couldn’t open it and had to wait until one of the younger men in Heather’s entourage came over and used a magnetic card.

“Thank you,” Brian said with forced dignity as he strolled out into the elevator lobby.

Chapter 10 August 31

Brian awoke Monday morning way before he intended but instantly knew he would not be going back to sleep. It was the characteristic whine of a mosquito that had rudely awakened him. Sitting bolt upright in bed, he listened intently. The sun had yet to come up, but dawn’s twilight filled the room with more than enough light for him to see. A moment later he caught sight of the insect as it landed on his upper left arm just above his elbow. For a split second he watched as it prepared to bite. He noticed that it was the same species that had plagued them at their beach barbecue, an Asian tiger, with its characteristic white marks on its black body and legs.

With fear-fueled speed, Brian slapped the insect with enough force to make his arm sting. The blow reduced it to a smudge of blood, suggesting it had already feasted. After using a bedside tissue to wipe off the remains, he bounded out of bed to check the open window. Sure enough, one corner of the screen was not fully engaged in its track, providing an opening to the outside. Brian quickly pulled it in tightly and set the small spring lock in place. With his heart racing, he climbed back into bed on his side and pulled up the covers, marveling at the fact that the Asian tiger mosquito could haunt such a highly urbanized area.

When he’d gone to bed just before midnight, he’d been totally exhausted both mentally and physically. The five or so hours of sleep he’d gotten clearly weren’t adequate, yet the confrontation with the pesky mosquito started him thinking. It was depressingly clear to him that there was no guarantee that things were going to improve as he faced another difficult week ahead. Rolling over onto his back, he stared up at the blank bedroom ceiling to make sure no other mosquitoes had gotten in. Although he knew more sleep was out of the question, he didn’t get out of bed, preferring to wallow in self-pity and lament his life. He’d never realized how tenuous it had been. Friday had started out bad, when a call from Calvin Foster’s executive secretary came in informing him that the October wedding had been canceled until further notice, meaning that even that modest potential income was off the table.

Right after that bit of disappointing news, Juliette had a meltdown while Camila tried to make her eat some breakfast. As if that wasn’t bad enough, then Brian started getting a flurry of calls on both the business landline and his mobile phone as well as multiple emails from a company called Premier Collections, which was threatening both a lawsuit over the $189,375.86 MMH Inwood bill and a sharp decrease in his credit rating if he didn’t immediately set up a payment plan. The harassing communications had shocked him after having had a face-to-face meeting with Roger Dalton just the day before. When he’d tried calling him for an explanation of why it was happening so quickly, he’d had to leave a voice message.

Continuing to stare up at the ceiling with unseeing eyes, Brian wondered how his bill was so astronomical, especially when he considered that MMH Inwood hadn’t really done anything besides just watch Emma go downhill. Except for handling the seizure in the ED, they hadn’t really treated her, and they certainly hadn’t cured her. In many ways, she was worse off when discharged than the day she walked into the Emergency Department. And then to truly add insult to injury, he had gotten three more non-hospital bills by email. The smallest invoice was from the ambulance company, Adultcare, who had had the nerve to charge nine hundred dollars to drive Emma about twenty blocks from MMH Inwood to the Hudson Valley Rehabilitation Hospital. At the time the MMH discharge people had arranged the transportation and if Brian had been given any warning about the cost, he would have driven Emma himself.

And then worse still were two other much larger bills from doctors. The biggest was from the neurologist who was not employed by MMH Inwood but had been asked to see Emma. The cost of his evaluation was $17,197.50. The second bill was for an out-of-hospital cardiologist in the amount of $13,975.13 after a nurse had possibly detected a few extra heartbeats when taking Emma’s pulse. In the end, Emma’s heart function was determined to be entirely normal, and all this meant was that his debt had reached a staggering $221,448.49.

The blaring of a horn accompanied by an angry shout out on West 217th Street briefly interrupted Brian’s thoughts, but a moment later he was back to his musing, specifically about how financially predatory and overly expensive the healthcare industry had become, particularly the hospitals. What he realized was that most people with good insurance, like he and Emma had had when employed by the NYPD, were ultimately complicit in allowing this ridiculous situation to happen. If hospital bills got paid, and of course they did, who cared or questioned how much the costs were, especially if trying to figure them out was practically impossible? Now he saw that such an attitude over time had contributed to allowing prices to climb exponentially, making it a recipe for disaster when someone lost their insurance or had bad insurance like the short-term policies Peerless offered. From his perspective it all amounted to a type of tolerated fraud, seeing as hospitals like MMH Inwood could create their own demand and then charge whatever they pleased. On top of that, less than ethical companies like Peerless could latch on and enjoy the ride while making a fortune.

As bad as Friday had been, Saturday was even more upsetting for Brian. It had started encouragingly enough when Aimée had called early and offered to come over and help with Juliette, whose behavior was getting worse. In many respects Juliette was as attached to her paternal grandmother as she was to her mother, and with Aimée present she’d eaten a decent breakfast for the first time in several days and for a while was her old self and content watching her cartoons. The reprieve gave Aimée and Brian a few moments to talk, which he used to share the disturbing news about Emma’s astounding hospital bill. Shocked at the amount, Aimée had suggested he contact a medical billing advocate.

“What the hell is a medical billing advocate?” Brian had asked. “I’ve never heard of such a person.”

“Apparently they help people with hospital bills,” Aimée had responded. “I hadn’t heard of them, either, but a friend of mine had a problem with an MMH Inwood bill and told me a billing advocate had helped her. The advocate’s name is Megan Doyle, and she has an office here. You should let her help you.”

Following that relatively pleasant morning and with Aimée entertaining Juliette, and Hannah expected to join them, Brian had gone to Hudson Valley Rehabilitation Hospital with the intent of spending the day with Emma. His plan was to get a true idea of how much rehabilitation she was actually receiving. But similar to what had happened at MMH Inwood on Thursday, as soon as he had entered HVR, he was told he needed to see Antonia Fluentes in the business office immediately.

With some trepidation Brian complied, but the moment he entered the woman’s office, he knew from her body language that trouble was afoot, and she confirmed it immediately.

“It’s been brought to our attention that your MMH Inwood bill is outstanding with no payment plan arranged,” Antonia said. She stared at him expectantly with dark, piercing eyes framed with equally dark glasses.

“It’s only been a few days since my wife’s discharge,” Brian said evasively.

“But we also have learned that your account has been turned over to collections. As you can imagine, that is not encouraging for us.”

“It’s not great for me, either,” he responded.

“We’ve also not had a good experience with your insurance carrier, Peerless Health.”

“That doesn’t surprise me,” Brian added.

“I’m sure you can see our dilemma. Due to the pandemic, Hudson Valley Rehabilitation Hospital has been struggling financially, like most healthcare facilities. To be perfectly honest, we are going to need upfront coverage for your wife if we are to continue with her rehabilitation.”

“I see,” Brian said, feeling like he was taking yet another low blow. “Exactly what kind of figure do you have in mind?”

“Minimally we are looking for two thousand dollars a day for the first ten days. At that point we can reassess the situation and her progress.”

“I’m afraid we don’t have a spare twenty thousand lying around.” He could hardly keep the sarcasm out of his voice.

“I figured that might be the case, so I spoke with our chief medical officer, Dr. Harold Spenser,” Antonia continued. “Medically he doesn’t see any reason your wife cannot be discharged and have her rehabilitation carried out at home by local physical therapists who will be up to you to retain.”

“What about somewhat of a lower advance, say, in the five-thousand-dollar range?” Brian said. “This would be a gesture of good faith to keep my wife here as an inpatient.”

“I’m afraid not. Your wife’s current bill is already almost five thousand dollars.”

At that point the conversation went downhill as he became incensed that Emma’s charges could already be at the five-thousand-dollar mark, considering she’d only been there two full days, the shabby state of the facility, what seemed like a lack of staff, and that she’d essentially received no treatment. In the end, it was decided that Emma had to be discharged, and to avoid another thousand-dollar ambulance bill, Brian had to drive her home himself.

Although getting Emma into the car had been a struggle, once they’d gotten underway, she perked up. “Being discharged was unexpected, but I’m looking forward to getting home,” she’d said. She was out of breath from the effort of climbing into the car’s front seat. There was no doubt her spasticity was worse.

“I can well imagine. We are all going to be thrilled to have you, especially Juliette, who’s really missed you.”

“I’ve missed her, too,” Emma confessed. “And how about the business? I’ve been afraid to ask.”

“Not good,” he told her regretfully. “There was a possibility of a wedding in October out in the Hamptons, but just yesterday it was canceled. Camila is constantly trying to scare up some business with social media.”

“How are our finances?” Emma asked.

“Also not good, I’m afraid,” Brian said with a wince. He’d not mentioned anything to Emma about the problems with Peerless or the hospital bill and didn’t intend to until she was fully recovered, seeing no reason to stress her out.

At first Emma’s homecoming had been well received, especially since both Aimée and Hannah were there to greet her with Juliette and Camila. Juliette was obviously thrilled, at least initially. But the bonhomie didn’t last, as Emma’s physical limitations and precarious emotional state put the festivities to a quick end. She quickly tired, had no patience with Juliette, who needed constant attention and reassurance, and soon just wanted to go to bed and sleep. Getting her up the stairs to the master bedroom became an exhausting ordeal for everyone; although she could walk on the flat with some difficulty, the stairs were almost impossible.

For him it had been the night that was by far the most difficult part, when he was left alone with his ailing wife. Although Emma had slept most of Saturday afternoon and evening, at night she was mostly awake, emotionally unstable, and rather restless, putting Brian’s patience to a true stress test. She even managed to fall out of bed around four a.m. On top of that was the difficulty of getting her from the bed to the toilet on multiple occasions. He’d barely slept a wink, and it also made him understand why it had been far better that he’d become a policeman rather than a medic, a notion he had entertained for a short time as a teenager.

Sunday had been spent trying to make the home situation tolerable for everyone. Luckily Hannah had an acquaintance with a late husband who’d been chronically sick and had required a hospital bed with guardrails for the last years of his life. Since she no longer needed the bed, she’d graciously offered it to Brian to install in the second-floor guest room, across from Camila’s room. To his great relief, Hannah had insisted she’d spend the night with her daughter to give him a break and a good night’s sleep.

The sound of the front door chimes ringing shocked Brian from his recollections of the past few difficult days, and he leaped out of bed, grabbing his robe in the process. As he headed for the stairs, he wondered who in God’s name could be ringing his doorbell before eight on a Monday morning.

Grabbing a mask off the console table in the front foyer and looping its strings around his ears, he pulled open the door. His wild rush had been hopefully to prevent whoever was there from impatiently ringing the doorbell yet again. About eight feet away, standing on the top step of a mini flight of stairs in the middle of Brian’s front yard, was a white-haired, moderately well-dressed gentleman in a white shirt, poorly knotted tie, and sports jacket. Despite only seeing the man’s forehead and his blue eyes through rimless eyeglasses above his face mask, Brian sensed that he vaguely knew the person. The man was holding an envelope in his right hand, although his arms were limp along his sides.

“Can I help you?” Brian asked, trying not to be irritated. It wasn’t a convenient time to be bothered, especially with the possibility of rousing Emma and Juliette. Thanks to phones and email, house visits of all sorts were rare these days, especially with the pandemic.

“I apologize,” the man said with a mild Irish accent. “Really I do.”

The combination of the sound of the man’s voice and the other visual cues brought some memories back. “Grady?” Brian questioned, tilting his head to the side to get a slightly different view. “Grady Quillen?”

“Yeah, it’s me. Sorry to bother you like this at the crack of dawn.”

“It’s not a problem. It’s not that early, Grady. I was awake, although the rest of the brood is still asleep. What’s up?” He recognized him as one of the patrolmen of the 34th Precinct when Brian’s father had been the commanding officer. He also knew Grady lived not that far away, on Payson Avenue in an apartment overlooking Inwood Hill Park.

“Believe it or not, I have to ask you if you are Brian Yves Murphy.”

“Is this some kind of a joke?”

“I wish,” Grady said, looking sheepish.

“How’s the family?” Brian asked. “Everybody staying well in this crazy time?”

“Yeah, we’re fine and healthy. Thank you for asking, but you are making this harder for me than it needs to be. Are you Brian Yves Murphy?”

“Okay, yes, I’m Brian Yves Murphy. Are you happy?”

“Hardly,” Grady said as he handed him the envelope. “After I retired from the NYPD five years ago, I sat around for a few months and drove my wife batty. You know the expression: ‘for better or worse but not for lunch.’ Then I took a job as a process server for Premier Collections. It’s kept me married and pays for the Jameson. I’m sorry, Brian.”

“So, I guess I’ve been served?” He looked at his name typed on the front of the envelope, and with his background in law enforcement he knew full well what it meant. The fact that Grady had become a process server didn’t surprise him in the slightest. Like being a commercial building security guard, being a process server was common for retired New York City patrolmen.

“I’m afraid so,” Grady said. “It’s a complaint and a summons. I apologize for being the bearer of bad news, but I couldn’t refuse just because I know you.”

“If you have a few minutes, let’s sit and chat,” Brian suggested while pointing down toward the ground. “Sorry I can’t invite you inside, so this will have to do.” He stepped out and sat on the single step leading up to his front door. Moving more than the mandated six feet away, Grady sat on his step and turned sideways. It was pleasant enough with the morning sun and mild temperature, surrounded by Brian’s shrub-and-tiger-lily-filled front yard.

After briefly leafing through the papers Grady had provided to confirm what they were, Brian replaced them in the envelope and looked up. “Please don’t feel in any way responsible for this. My getting served is not unexpected except for the speed involved. If this was going to happen, I thought I’d at least have the usual thirty days.”

“It’s been my experience that MMH Inwood has been progressively aggressive with collections over the last few years,” Grady said, “but with the pandemic throwing a monkey wrench into the hospital’s finances, it’s gone through the roof.”

“So I’ve heard.”

“To give you an idea, just since March they’ve had me running ragged, averaging ten to fifteen services a week. And I’m not the only Premier process server. There’s three of us.”

“Are you guys serving just people in Inwood?” he asked, taken aback by the numbers from just one community.

“The vast majority,” Grady said. “There’s always a few from Hudson Heights.”

“How do you know it’s the hospital behind the uptick and not the collections people themselves?”

“That’s easy. The hospital actually owns Premier Collections. They are part and parcel of the same organization.”

“You’re kidding?” Brian questioned, even more shocked by this than by the numbers. Learning that MMH Inwood was in the collection business meant that the hospital was even more predatory than he thought.

“I’m not kidding in the slightest,” Grady said. “It’s all the brainchild of the hospital CEO, Charles Kelley.”

“How do you know?”

Grady gave a short, sardonic laugh. “I know because he’s a cult figure around Premier Collections and with the hospital admin people, too. They all think he’s a financial genius. He’s also liberal with the MMH stock with higher-up employees, meaning, of course, I’ve been out of luck. I tell you, if I had any extra cash, I’d buy some of the MMH stock because I hear that it’s a winner, constantly going up.”

In an uncomfortable way, Charles Kelley and his tactics were sounding rather similar to Heather Williams’s business model.

“I’d like to meet this Charles Kelley sometime,” Grady continued. “I’ve heard his compensation is more than five million per year. Can you imagine? I think the only hospital CEO who makes more is the guy who runs the University of Pittsburgh Medical Center. He gets over six million. It’s crazy.”

Knowing the ridiculous amount of money he owed from Emma’s seven days of hospitalization, he could now believe it rather easily. He’d never had any idea what an impressive gold mine medical care could be.

“So, what are you going to do about this situation?” Grady asked. “As a friend, I want to make sure you know you have to respond to the summons within thirty days or there will be a summary judgment against you.”

“Yeah, I know,” Brian said.

“Obviously I couldn’t help but see that MMH Inwood is suing you for almost one hundred and ninety thousand dollars. Who in your family needed hospitalization?”

“My wife, Emma,” he told him. “She caught a bad mosquito-borne illness while we were on Cape Cod. It isn’t contagious, if you are worried.”

“I’m not worried,” Grady said. “What a bummer. How is she doing?”

“So-so,” Brian admitted, unwilling to provide any specifics. “At least she’s home.”

“I’m glad to hear it. What’s the story with your health insurance? I heard you and your wife were with the ESU.”

“We were until we retired in December to start our own security company,” Brian said. He was getting tired of explaining. “When we retired, we lost our city insurance and were forced to rely on a short-term policy that’s not worth the paper it’s printed on. They aren’t contributing a penny.”

“Ouch,” Grady said. “Have you talked with a lawyer?”

“Not yet. That would cost more money.”

“Money well spent,” Grady said. “Take my word.”

“I think I’ll go back and try to reason with the MMH Inwood business office and come to some understanding.”

“From my vantage point the chances of that helping are piss poor. You need a lawyer, because Premier is dogged. I’m telling you: They won’t give up, and they’ll go after everything, including your house. By the way, this is one of the nicest houses in Inwood.”

“We were lucky to get it.”

“I’m serious about Premier being hard-nosed. You might know a neighbor of mine, Nolan O’Reilly.”

“I know the family,” Brian recalled. “What about him?”

“I had to serve him. He ended up losing everything, and his and his wife’s salaries have been attached from now until hell freezes over.”

“Was that a hospital bill, too?” he asked.

“It sure was, about twice yours. It involved surgery on their son, and to make matters worse, the kid died.”

“That’s awful.”

“I know a lawyer,” Grady continued. “He’s down on Broadway. A local kid, and he’s really good. I gave his name to my neighbor, and he fell over backward trying to help him.”

“Is this the neighbor who lost everything?” Brian asked.

“Unfortunately, yes.”

“That’s not a very good advertisement for your lawyer acquaintance,” Brian countered.

“I know it sounds that way, but my neighbor had failed to respond to the original summons, and there had been a summary judgment. When that happens, it’s almost an impossible uphill struggle, so please respond!”

“I’ll definitely take care of it. What’s the lawyer’s name?”

“Patrick McCarthy.”

At that moment, he saw Aimée turn into the walkway, carrying a white bag from CHOCnyc, an Inwood French bakery. Both Brian and Grady immediately got to their feet. She stopped when she saw Grady, and like Brian had done earlier, she tilted her head and wrinkled her forehead, obviously recognizing him on some level but struggling to place him.

“Hello, Mrs. Murphy,” Grady said to help her. “It’s Grady Quillen.”

“Oui, Grady Quillen,” Aimée repeated. “So nice to see you again.”

“I’m sorry about Deputy Inspector Murphy’s passing,” Grady said, bowing his head.

“Thank you,” Aimée responded kindly. “It was a shock to us all.” Brian’s father had died of a heart attack a year and a half earlier while on the job as commanding officer of the local precinct.

After a few minutes of small talk, Grady went on his way, saying he had more work he needed to do. After he was out of sight, Aimée turned to Brian. “What was he here for so early?”

He waved the envelope. “He’s a process server, and he served me. I’m afraid MMH Inwood is already suing me for Emma’s care.”

“C’est terrible,” Aimée said, worry creasing her face. “Why so soon?”

“It is terrible,” Brian said, mimicking his mom’s French accent. “I feel like my life is coming apart at the seams, and I don’t even know where to begin to try to fix it.”

Chapter 11 August 31

It was just after eleven o’clock in the morning when Brian slowed his running pace as he neared MMH Inwood and then jogged up the driveway. As religious as he’d been about keeping himself in superb physical shape with weight training and cardiovascular exercise since high school, he seriously missed his daily workouts and hoped that with Emma at home and Aimée and Hannah offering to help, he could get back to some semblance of a routine. His mother and Emma’s mother certainly had helped that morning and had allowed him and Camila to spend a few hours in the home office brainstorming potential ways to drum up business for Personal Protection LLC. While they were strategizing, several more harassing calls came in from Premier Collections, confirming Grady’s assessment of their persistence.

After having been duly served with a complaint and summons, Brian had been eager to see Roger Dalton in the hopes of stopping the collection process, so as soon as he could, with Aimée’s and Hannah’s blessings, he’d set out. Now as he entered, he wondered if his visit would turn out to be worthwhile. After Grady’s estimate that the chances of reversing anything were “piss poor,” he wasn’t optimistic, but he couldn’t see any harm in trying.

As he entered the hospital’s swank admin area, he was reminded that he’d always thought of MMH Inwood as a positive asset to the community. Now he was thinking the opposite, especially knowing how many other Inwood residents were being pursued for collection of most likely seriously inflated hospital bills.

Brian had not called ahead, preferring just to show up and plead his case. But he soon began to think he’d made a mistake, as he was subjected to a considerable wait. When he was finally ushered into the office, Roger added to his pessimism by announcing that Brian had better make it quick, as he didn’t have much time.

“I’ll try to be fast,” he said, struggling to control his emotions. He was beginning to hate this thin wasp of a man. “I’m shocked and disappointed that my case has already been turned over to Premier Collections and they are already hounding me. From my memory, that’s legally questionable. Besides, you and I have been in continuous contact, and you know that I am taking this situation seriously enough to have made a personal visit to Peerless Health Insurance late last week.”

Sighing with boredom and annoyance, Roger tented his skinny, gnarled fingers. “To be honest, I didn’t have any choice, not under these trying times. Turning a case over to collections immediately has become standard policy dictated from above when it’s obvious the situation is futile, which is what you have led me to believe. You refused to set up an agreeable payment plan. Case closed.”

“I can’t set up a payment plan in this financial environment with the pandemic going on,” Brian said irritably. “My company’s income these days is zero.”

“That’s my point precisely,” Roger said. “You are not going to agree to a reasonable payment plan. So we agree.”

“What exactly do you mean, ‘dictated from above’?”

“Exactly as it sounds,” Roger answered.

“How far above?”

“The top.”

“Let me ask you this,” Brian said. “Does MMH Inwood own Premier Collections?”

“Why do you ask? What difference does that make? You owe what you owe.”

“I think it makes a lot of difference,” Brian argued. “And your response certainly confirms my suspicion. When you say policy is dictated from the top, I assume you mean the CEO, Mr. Charles Kelley?”

“Obviously,” Roger said as if progressively bored by the conversation. “He is the chief executive officer, after all.”

“So he must be really hands-on if he’s concerned about the nitty-gritty goings-on in the hospital, like collections and speeding up the process.”

“Oh, yes,” Roger said with emphasis. “Mr. Kelley is the man behind MMH’s financial success and massive building campaign. Both this campus and MMH Midtown have been totally renovated, bringing everything up to twenty-first-century standards. All that takes money, so Mr. Kelley has made us, the Business Department, feel as essential to the hospital mission as any other department. Charles Kelley is a superb businessman. Mark my words!”

“I’m beginning to think ‘ruthless’ might be closer to the truth than ‘superb,’ ” Brian said. “Did you know that I have already been served?”

“I did not,” Roger said. “But I’m not surprised. Once an account is moved to collections, I’m no longer involved.”

“I’d like to get you reinvolved and hold up the legal maneuvering. Why don’t you and I go back to talking about some kind of goodwill payment to carry us through this pandemic?”

“That’s not possible.” Roger shook his head firmly.

“Why not?”

“Mr. Kelley, the superb businessman he is, has insisted that Premier Collections operate as a separate entity even though owned by MMH Inwood. For accounting and tax reasons, Premier has bought your debt. I’m no longer involved, so you have to deal with them from now on.”

“But if Charles Kelley were to give you license to get reinvolved, would that work?”

“Obviously,” Roger said with a dismissive laugh, as if that was the most ridiculous idea he’d heard all day. “But that’s not going to happen.”

“How often does he come here?” Brian asked. He’d noticed that on all his recent visits to the MMH Inwood admin area, Charles Kelley’s office and its neighboring fancy conference room were empty.

“Not that often. Maybe once or twice a week. He’s mostly at his MMH Midtown office, which is a facility four times the size of this one.”

“Is he approachable?” Brian asked. “I mean, could I set up a meeting with him? As good a businessman as you think he is, maybe he should hear from someone in the community being adversely affected by his policies. Ultimately, he must be concerned about the hospital’s image in the community, which I think is suffering. I’ve learned I’m not the only one being sued.”

Roger laughed even harder than he had a moment earlier. “You would not be able to arrange a meeting with Charles Kelley,” he scoffed. “No way. His time is inordinately valuable. Besides, he doesn’t have the time to get involved with individual patient accounts.”

“Maybe he should be,” Brian insisted. “As a businessman in a service industry, I would think he’d be very interested in the hospital’s image. What do you think about me approaching him on my own?”

“He wouldn’t waste a minute talking with you,” Roger said. “I’m telling you: He’s a very, very busy man. Besides, you’d be taking a risk going up to him unannounced.”

“How so?” Brian asked.

“He has an armed driver.”

“Why would a hospital CEO need an armed driver?” Brian asked. As a security-minded individual, Brian was legitimately interested.

“Because he is an inordinately important man running several large institutions,” Roger said impatiently. “It’s to protect him from people like you, if you want to know the truth. What a ridiculous question.”

“Okay,” Brian said, trying to maintain his composure. “Let’s move on to another issue. Did you or anyone here make it a point to contact the Hudson Valley Rehabilitation Hospital and report that my wife’s hospital bill had been turned over to collections?”

“I can’t imagine. It certainly wasn’t me, if that is what you are implying.”

“Someone did,” Brian said. “Last week I was dragged into their business office and presented with an ultimatum: Either I came up with a twenty-thousand-dollar advance or my wife was going to be booted out for the second time because of nonpayment of exorbitant hospital charges.”

“I resent that statement,” Roger said irritably. “It seems you’re implying that your wife was discharged from here because of nonpayment of her bill and that our charges are not appropriate. Both statements are patently untrue, as I’ve told you before.” He stood up. “This meeting is over. I want you to leave, or I am going to call security, and they will throw you out.”

For a brief moment of irrationality, Brian fantasized about refusing to leave in hopes of having a half-trained hospital security person or two try to throw him out. Instead, feeling chagrined at being summarily dismissed after he’d made a sincere effort to come in and resolve the hospital bill problem, Brian stormed out of Dalton’s office. Cursing under his breath and feeling a searing anger at a system designed to make money more than anything else, he strode toward the door leading into the hospital lobby. But on his way out he couldn’t help but stop and stare in at Charles Kelley’s empty office and fancy glass-walled conference room.

Motivated by morbid curiosity, Brian walked in through the open office door. He was looking for the equivalent of Heather Williams’s ostentatious foxhunting portrait, and he wasn’t disappointed. Hanging above a faux fireplace was a nearly full-sized painting of a blond-haired middle-aged man in a three-piece business suit, arms folded, leaning up against an impressive desk similar to the real one in the room. Just to be certain, Brian approached to read the engraved plaque. It was indeed Charles Kelley. Although pictorially tame in contrast to Heather’s outlandish portrait, Charles’s painting conveyed the same sense of entitlement and privilege, with an equally haughty, superior-than-thou smile. “Two birds of a feather,” Brian observed out loud as he shook his head in disgust.

“Excuse me!” a voice called. “What are you doing? You are not allowed in here!”

Brian turned to face a secretary clearly outraged at his violation of Charles Kelley’s inner sanctum.

“Just enjoying the artwork,” Brian said with a fake, innocent smile.

A few minutes later as he was passing out through the main entrance’s revolving door, with his irritation and anger still at a boiling point, Brian thought again about the two CEOs and how they seemed to be poster children for what was wrong with American medicine and unbridled entrepreneurial capitalism. And as a doer, he knew he couldn’t just passively allow their greediness to go unchallenged and dictate the unraveling of his life. He had to do something. He just didn’t know what.

Chapter 12 August 31

As Brian turned from Park Terrace East onto West 217th Street and slowed to a walk on his torn-up street, what was becoming progressively clear to him was the need to retain a lawyer despite the added cost. The question was: Should he use the counselor Grady suggested, who had some experience dealing with MMH Inwood, or should he use a lawyer from the white-shoe firm he and Emma had employed to set up Personal Protection LLC? As he climbed the stairs in the middle of his front yard where Grady had been sitting that morning, he decided to give Patrick McCarthy a try, as the cost would undoubtedly be appropriately and remarkably less. But that wasn’t the only reason. Brian also thought that Patrick’s experience with MMH could be significant in addition to his being a local boy. In a community like Inwood, being part of the neighborhood made a difference.

Reaching the top step and despite his preoccupations, he paused. He couldn’t help but appreciate his surroundings. He was standing with his profusion of riotously beautiful orange tiger lilies flanking both sides of the walkway, which had been planted by the house’s previous owners in lieu of a minuscule lawn. After admiring the flowers, he then looked up at his home with its striking Tudor revival mixture of brick and stonework. He and Emma loved the house and had admired it during their childhoods. Brian was proud that they owned it, but now, with MMH Inwood’s Premier Collections on his case, he knew that the property was potentially in jeopardy. The thought shocked him back to reality and reawakened the anger he’d felt in Roger Dalton’s office, forcing him to try to think about something else.

The something else was what he would be confronting once he entered through the front door. The one positive thing that he hoped would have resulted from Emma’s being kicked out of two hospitals was that her presence at home would have drastically improved Juliette’s attitude and behavior. But that hadn’t happened. If anything, Juliette’s apparent anxiety was even worse because Emma’s illness made it difficult for her to meet her daughter’s needs. As a result, Juliette was back to refusing to eat, was again voicing vague bodily complaints, and was displaying frequent temper tantrums.

Brian’s worst fears were substantiated the moment he entered through the front door. Standing in the foyer and removing his shoes, he could hear both his wife and his daughter distantly sobbing and complaining, one from the kitchen and the other from the upstairs guest room. Flipping a mental coin of which situation took precedence, he first went into the kitchen. Juliette was sitting in the breakfast nook and Camila was at the sink washing a frying pan. For a brief moment Brian and Camila exchanged a glance and Camila rolled her eyes.

He slid into the banquette alongside Juliette. In front of her on a plate was a freshly made grilled cheese sandwich. “What’s the matter, my sweet?” Brian asked. Juliette cried harder.

“She said she was hungry for a grilled cheese,” Camila said. It was obvious her patience was being tested. “Now she won’t eat it.” Camila finished with the pan and then turned to face the room, leaning back against the sink arms akimbo.

“Why are you not eating?” he asked his daughter.

Choking on her tears, Juliette managed: “I don’t feel good.”

“I’m sorry, sweetheart,” Brian said. He looked over at Camila, who was at her wits’ end. “Why don’t I spend a little time with her?”

“I’d appreciate that,” Camila said, and immediately left the room.

“If you don’t want to eat, what do you want to do?”

“I want to watch cartoons with Bunny.” Bunny was propped up against her as per usual.

“Why don’t you?” He pushed the TV remote in Juliette’s direction.

“Camila said I couldn’t until I finished my sandwich.”

Brian guessed there had been a mini test of wills, which wasn’t uncommon or unusual considering both individuals’ personalities. He took the remote and turned on the TV. “What do you mean when you say you don’t feel good?” Brian was curious about Juliette’s ongoing long list of mild complaints, which had started with Emma’s seizure and hospitalization, and had only gotten worse since her homecoming.

Juliette rubbed her hand vaguely around her stomach, which is what she’d done previously when he had asked for specifics. “And my head hurts.”

“I’m sorry you are not feeling well. Does Bunny have the same symptoms?”

Juliette nodded.

“The more I check out that grilled cheese sandwich, the better it looks,” Brian said. “Do you mind if I have a bite?”

Juliette pushed the dish in his direction. Brian took a bite and chewed thoughtfully. “Not bad! Actually, really good! Maybe you should let Bunny give it a try.”

After offering the sandwich to Bunny to take a bite, Juliette took one herself. Brian purposefully didn’t comment. Instead, he was content to just sit with her and enjoy a portion of a Curious George episode. As they watched, Juliette toyed with her food without eating any more, until Camila eventually returned.

“I’m sorry,” Camila said. “I don’t know what came over me.”

“Don’t be silly,” he said, waving her apology away. “I understand completely. We’re all under stress.”

“I think you’d better see if you can help Aimée and Hannah. They’re having a difficult time with Emma.”

“Right!” Brian slid out from the breakfast nook. The whole time he’d been in the kitchen, he’d occasionally heard distant sobbing and raised voices. With some apprehension about what he was going to face, he climbed the stairs. If both Aimée and Hannah were struggling, he thought the chances he could help were mighty slim.

The hospital bed was in the center of the room with the head pressed up against the wall between the two windows that looked out over the driveway and the neighboring house. The guest room bed, where Hannah had spent the night, had been pushed back against the common wall with the hallway. Aimée was on one side of the hospital bed and Hannah on the other, while Emma was lying in the bed with her upper body on a towel. Her face was streaked with tears, and a basin with soap and water was on a stool on Hannah’s side. As Brian entered and approached the foot of the bed, Hannah draped a towel over Emma’s midsection.

“She’s refusing to let us bathe her,” Hannah explained with irritation.

To Brian it was clear that everyone in the room was emotionally overwrought. The question was: What to do?

“I want to take a shower,” Emma complained, her voice catching. “They won’t let me!”

“It’s too dangerous,” Hannah lectured. “You are not walking right, and you might fall. Then you’d be worse off than you are now.”

“It’s true,” Aimée added.

“How about a bath in the master bathroom?” Brian offered. It was clear Emma was feeling ganged up on, and the guest room bath only had a shower.

“That might work, but only if she lets us get her there and then back to bed,” Hannah stated as the domineering mother she’d always been.

“How about you guys take a coffee break?” he suggested, trying to be diplomatic toward Aimée and Hannah. Since he was highly dependent on their help, the very last thing he wanted to do was offend them in any way. “I think I’d like to have a few moments with my wife.”

Aimée and Hannah exchanged a questioning glance, then reluctantly agreed. They filed out without another word. Hannah, who was the last to leave, closed the door behind her.

“I don’t want to be here,” Emma said, surprising Brian. Over the last few days, she’d been suffering various stages of confusion. But now she sounded not only oriented, but lucid and almost like her old self. “I feel that I’m getting worse, not better. I need to be back in the hospital so I can be treated to get back to normal.”

Brian nodded but struggled with what to say. After he had read that the vast majority of encephalitis survivors ended up with serious neurological deficits, he was reluctant to bring up the issue of what getting back to normal was going to mean. He also wasn’t prepared to explain to her why it wouldn’t be possible to get her back into MMH Inwood, even if that was what she preferred and even if it made the most sense medically. The whole situation was much too complicated and heartbreaking.

“Besides, I’m a big burden being here at home,” Emma continued as new tears formed in the corner of her eyes.

“You are not a burden,” Brian said, trying to protest but knowing in many ways that her presence was more difficult than he had expected. He gave her a hug and then gripped her hand. “And your mother and my mother are thrilled you are here. They see it as an opportunity, certainly not a burden. They’re happy to help.”

Taking advantage of her sudden lucidity, he broached the subject of Juliette. Brian could tell that she was horrified to learn that her actions since arriving home on Saturday had exacerbated Juliette’s behavioral problems.

“I had no idea,” Emma said regretfully. “I hardly remember anything since I’ve been here, which is scary.”

“She’s missed you terribly. If I had to guess, I think it’s mostly from having witnessed your seizure in the car. That’s frightening for anyone, especially a four-year-old who’s as close to her mother as Juliette is to you.”

“Oh, gosh! I’ll have to make it up to her. It just makes me feel awful, the poor thing. She’s been through a lot.”

“It’s certainly not your fault,” Brian said. “But anything you do or say will undoubtedly help.”

Without any warning, Emma pulled her hand away from his and slapped her palm to her head, gripping herself hard enough that her forehead wrinkled and knuckles blanched. At the same instant, her other hand noisily grasped one of the bed’s metal guardrails. Shocked by the sudden motion and noise, Brian blinked and retreated a full step backward.

“What’s going on? What happened? Are you okay?”

Emma withdrew her hand, blinked, and looked over at him. “Wow! That was strange. I guess I’m okay. I just had a sudden jolt, and now I have a headache.”

“Do you want me to get you something? An ibuprofen?”

“No, I’m okay. I just feel a little odd, and the headache is already going away.”

Brian moved back alongside the bed and gripped Emma’s arm. “Are you sure?”

“Yes, I guess.” She blinked several times. “What I’d like to do is get this ridiculous bath conundrum over with. As much as I hate to admit it, my mother is correct about it being dangerous to try to shower in my current state. I don’t want to fall, nor do I want to burden them with giving me a bed bath like I’m a child.”

“Okay, I’ll run the bathwater,” he said. “And then can I call the mothers back? They are desperate to help.”

“I guess. Sure. Call them back! Meanwhile, put down one of the guardrails so I can sit here for a few minutes on the side of the bed to adjust to being upright. What will you be doing while I take a bath?”

“If you don’t mind, I’ll spend a little more time with Juliette.”

“Good idea,” Emma said, sounding like her old self. “Tell her that I look forward to seeing her after my bath.”

“I’m sure she’ll like to hear that,” Brian said, giving his wife’s arm a reassuring squeeze.

Chapter 13 August 31

After spending nearly a half hour with Juliette watching Ask the StoryBots and getting her to eat the rest of her grilled cheese sandwich, Brian was glad she seemed back to near normal. When she and Camila began coloring together, Brian had checked on Emma’s situation before retreating to the home office. His plan was to try to get an idea of what they would be able to cover with their current depleted cash reserves if they were forced to endure the entire fall season with few or no security gigs, which was how it was beginning to appear. The reality was that by the New Year, they were going to be in bad shape even with Camila gracious enough to be willing to defer receiving her salary. The thought of losing her, especially under the current circumstances with Emma and Juliette, was painful.

While deep in his depressing thoughts, a sudden nerve-shattering, shrill scream reverberated around the room, sending a shot of adrenaline through Brian’s body and propelling him out of his desk chair and into the hallway. Instantly he could tell the continued shouts were coming from above, although already there was an answering softer wail from the kitchen. Brian hit the stairs at a run and within a blink of an eye he’d reached the guest room. Inside he found both Aimée and Hannah frozen like statues with their hands clasped over their mouths and eyes thrown open to their limits.

Within the hospital bed Emma was in the throes of yet another full-blown seizure, with her back arched grotesquely and her arms and legs thrashing. Most disturbing of all, her head was repeatedly hitting against the bed’s protective metal rails and making a horrific clamor. Without a second’s hesitation Brian rushed to the bedside and pulled his convulsing wife more into the center of the bed to prevent any head trauma. With Brian’s arrival, the mothers’ screams trailed off.

“Thank God you came,” Aimée wailed. She stepped closer to the bed. Hannah stayed away, her hand still clasped over her mouth.

“What happened?” Brian managed as he forcibly kept Emma away from the bedsides and struggled to roll her on her side, so she didn’t choke. As muscular and athletic as Emma was, it took all of Brian’s considerable strength.

“I don’t know! Nothing particular. She’d had her bath, and we’d managed to get her back into the bed, which wasn’t easy. It did make her really upset. Could that have caused this?”

“I can’t imagine,” Brian said, struggling to keep Emma centered in the bed and on her side. He noticed she was turning slightly blue from her breathing being suppressed.

“Should I find something to put in her mouth so she doesn’t bite her tongue?”

“No, it’s not necessary,” Brian said. “That’s an old wives’ tale. It’s enough to keep her on her side and keep her from injuring herself.”

“Should one of us call an ambulance?” Hannah asked frantically. She’d recovered to a degree but still hadn’t moved from where she had backed up.

Brian didn’t answer immediately because he didn’t know what to do and keeping Emma centered was taking all his attention. He assumed the seizure would stop just as it did when she’d had a similar fit in the car on the way back from the Cape. But as the minutes ticked by, Brian got progressively frantic, especially since she was only getting bluer in the face.

“Hannah!” Brian yelled over his shoulder. “Go ahead and call an ambulance!”

Glad to have something to do, Hannah struggled to get her phone out of her pocket. She hit emergency and dialed 911, then put her phone to her ear.

“Tell the operator it could be a status epilepticus!” Brian shouted. “Tell them that an ALS ambulance is needed.”

“What’s an ALS ambulance?”

“Advanced life support!” Brian shouted back.

Since Emma’s convulsions were still making considerable noise in the hospital bed, Hannah stepped out into the hallway. A moment later, with the phone still pressed against the side of her head, she returned and called out to Brian: “How long has the seizure been going on?”

“I don’t know,” Brian cried. “Say five minutes.”

Hannah left again but was back quickly to stand next to Aimée. “Okay, an ALS ambulance is on its way.”

Brian didn’t answer. His concerns were quickly mounting as his wife was even more blue than she’d been just a few moments earlier. “Hurry, please!” he said under his breath.

“C’est très inquiétant!” Aimée said, catching Brian’s words despite the noise Emma was making.

“Of course it’s worrisome!” Brian responded irritably at what he thought was a foolish thing to say.

Suddenly a pitiful scream crying “Mommy!” penetrated the clatter Emma was making in the bed. All eyes turned to the doorway to see Juliette’s form silhouetted against the backlight.

Aimée was the first to react, and she rushed to the doorway and guided Juliette away with soothing words. A moment later Camila appeared, taking in the commotion. “I’m so sorry,” she blurted out. “I turned my back just for a second, and Juliette was out of the kitchen.”

Brian didn’t answer. As the seconds ticked by and Emma’s lividity deepened, he was getting more and more concerned, since Emma’s seizure was now at least twice as long as her first. “Someone should go down to the front door and let in the ambulance medics!” he shouted to no one in particular.

“I’ll go,” Camila said quickly, glad to do something to appease her guilt. She disappeared before anyone could respond.

“Will the medics be able to stop the seizure?” Hannah asked nervously. Though clearly still distraught, she’d recovered enough to come around the bed and was standing across from Brian.

“Who the hell knows!” Brian snapped insensitively. He was becoming so concerned himself that he wasn’t thinking properly.

After what seemed like hours but had been only ten to fifteen minutes, undulating sirens could be heard. It was music to Brian’s ears. From the sounds he could tell there was more than one vehicle, which surprised him. Quickly the sirens reached a crescendo, and then trailed off and stopped, indicating the vehicles were outside. A few minutes later four medics, one woman and three men, rushed into the guest room carrying a wide variety of equipment, including a stair chair used to get patients up and down flights of stairs. All of them were outfitted in full protective gear due to the pandemic.

The woman, clearly in charge and taking command, crowded Brian to the side. The noise from Emma’s thrashing became louder. “I’m Alice, a paramedic, and this is George, my partner,” she said quickly, motioning to the man who had gone to the other side of the bed. He was carrying an instrument case. “How long has the patient been convulsing?”

“I’m not sure,” Brian admitted, but he knew it was important to give an answer. “Probably more than twenty minutes.” Brian, along with Hannah, backed up into the doorway leading out into the hall.

“Okay!” Alice said, looking at George. “Break out the Arrow Intraosseous drill.”

“What do you want for the injection?” George yelled as he opened the case and took out what looked like a normal carpenter’s drill.

“Versed, five milligrams,” Alice said. Then, looking at the two other medics, she added: “Tom, I need a glucose! And, Bill, set up an oximeter! She’s looking way too cyanotic. And set up oxygen with a nasal cannula.”

“I can’t watch this,” Hannah said, and fled to find Aimée, Juliette, and Camila.

Brian stayed riveted where he was. Although worried sick about Emma, he couldn’t help but be impressed and reassured with the speed and confidence the medics were displaying. Most impressive was how much modern medics could do in the field. In olden times, meaning just a decade or so earlier, ambulance drivers were just that: drivers. They went out and brought victims to the hospital for care. Nowadays it was totally different, with paramedics starting lifesaving treatment right at the scene just like they were doing here. He was hopeful that they’d be able to stop the seizure quickly.

To Brian’s great relief, within only a minute or so after the intraosseous injection, Emma’s agonizing full-body contractions slowed and then mercifully disappeared altogether. Quickly the medics took her vital signs. Alarmingly, Brian could see that Emma hadn’t regained consciousness despite the seizure having stopped.

“Pulse is steady and blood pressure is low,” Alice said, removing her stethoscope from her ears. “How about her oxygen level?”

“Not great,” George said. “Below ninety but she seems to be breathing okay.”

“Let’s hook up an ECG and get her into the stair chair,” Alice said. “Come on! Move it! We have to get this one to the ED now!”

Tom and Bill picked up the stair chair and brought it next to the hospital bed, which gave Brian an idea of the hierarchy with the medics. Alice and George were paramedics, manning the ALS ambulance, and Tom and Bill were EMTs probably manning a BLS ambulance, or basic life support. As Tom and Bill organized the safety straps in preparation for securing Emma in the carrier, Alice and George collapsed the hospital bed’s rails in unison. The moment they did, almost as if in response, Emma exploded into another full-blown seizure.

“Draw up another ten milligrams of Versed!” Alice barked while she and George made sure Emma didn’t convulse herself off the bed now that the side rails were lowered. A few seconds later Alice was handed the appropriately filled syringe, which she used to inject the drug into the cannula still positioned into Emma’s marrow cavity. Emma’s convulsions immediately began to slow and then stopped. Alice was pleased until she tried to take Emma’s blood pressure, at which point she realized that Emma had no blood pressure and no pulse, even though the ECG that George had attached was showing a slow but regular heartbeat. She wasn’t breathing, either.

“Good lord!” Alice exclaimed. “We’re looking at PEA. Start CPR stat!”

George climbed up onto the bed to start chest compressions. Alice took an ambu bag from Tom, attached the oxygen line to it, and then started respiring Emma.

Brian was horrified at this sudden turn of events, watching his thirty-four-year-old wife being given CPR and knowing she was at death’s door. It was as if he was caught in a nightmare and couldn’t wake up. Nor could he even move.

“How the hell could she have PEA?” George demanded between compressions.

“I don’t know for sure, but I suspect loss of vascular resistance,” Alice said. “Tom, draw up one milligram of epinephrine and give it stat.”

“Circulatory collapse from anoxia?” George asked. He paused momentarily to allow Tom to connect a syringe to the tibial cannula.

“Yes,” Alice said. “This is the kind of case where I wish to hell we had the capability for some kind of emergency electroencephalographic tracing to be one hundred percent, but that’s my guess. Well, more than my guess. It’s the only explanation.”

Despite feeling like he wanted to run away and hide, Brian couldn’t move. Knowing things had just gone from bad to worse, he was desperate to at least understand what was happening, so he managed to lean toward Bill, who for the moment was idle. “What’s PEA?”

Obviously distracted, Bill still turned to Brian. “Pulseless electrical activity,” he said. “The heart’s trying to beat, but it can’t. It usually means there’s little or no blood coming into the heart because it’s all pooled peripherally due to circulatory collapse.”

Before Bill could explain more, Alice called out to him to run down on the double and bring up the Lucas CPR, a battery-driven cardiac compression device. As Bill headed out the door, he had to dodge Hannah, who was on her way in. Fearing what she was about to see, Brian intercepted her, blocking her view of the spectacle taking place.

“What’s happening?” Hannah said, trying to peer around Brian’s body. “How is Emma doing? Has the seizure stopped?”

“It’s important for you and everyone else to stay out of the way,” Brian cried out, purposefully evading Hannah’s question. “Where is Aimée?”

“She’s in the kitchen with the others. I just want to be sure Emma is okay.”

“They are attending to her,” Brian said evasively. “Really, it’s better for you not to be here.” To back up what he was saying, Brian herded Hannah out the door into the hallway. At that moment Bill was rushing up the stairs carrying the Lucas device, and he squeezed past into the guest room. “They’ll be taking Emma to the hospital very shortly,” Brian added. “You join the others. I’ll go along with Emma if possible, and I’ll call you guys just as soon as I can.”

“All right,” Hannah said reluctantly, and backed up a few steps. She then fled down the stairs.

When Brian returned to the guest room, he could hear from Alice’s order that Tom was giving yet another dose of epinephrine, a major cardiovascular stimulant, meaning the first dose probably hadn’t had any effect. Stepping over to the foot of the bed, Brian spoke to Alice, who, with George, was rapidly setting up the Lucas. “I’ve had EMT training,” Brian said. “Can you tell me what’s happening here?”

“Sorry. We’ve got to get this patient out of here. I don’t have time to explain.”

Once they had the Lucas machine giving the chest compressions, they transferred Emma from the hospital bed to the stair chair. It was obvious to Brian that these people had prior experience working together since everyone knew their role without a lot of talk or direction. Then with Alice walking alongside and doing the breathing, Tom and Bill maneuvered the stair chair out of the guest room, down the stairs, and out the front door. George brought up the rear carrying the rest of the equipment. Brian followed, grabbing a face mask off of the foyer’s console table and putting it on. Outside, a few of the neighbors who’d come out of their homes in response to the sirens silently watched as Emma was rapidly loaded into the ALS ambulance. For Brian there was a sense of unreality about the whole scene, especially with everyone wearing face masks. It was as if he were participating in a science-fiction horror movie. Alice leaped in the back to ride with Emma. George started for the cab, but Brian grabbed his arm.

“She’s my wife,” he rasped. “Can I ride in the ambulance?”

“Of course,” George said. “Hop in!”

As Brian climbed into the front of the ambulance, he felt even more like he was caught in a nightmare that he couldn’t escape. The fact that his wife was in the back, fighting for her life, seemed so far-fetched that it couldn’t possibly be true.

Chapter 14 August 31

Riding in the ambulance with the siren wailing was a true déjà vu for Brian, reminding him of countless trips he’d made in one of the ESU heavy vehicles speeding out to handle some kind of disaster like an active shooter or a hostage incident. When you were a member of the NYPD ESU, most every call was a serious event, which required being prepared for the worst. The good and bad part of that was it was never boring like being a patrolman could be. As the ambulance drew closer to MMH Inwood, he found himself wishing he was back on the force and in an anonymous ESU transport, as it would mean Emma wasn’t in the back struggling for her life.

George and Alice had used the radio to let the MMH Inwood Emergency Department know what they were facing, namely a patient in extremis and receiving CPR. Brian heard the back-and-forth exchanges with growing alarm. What tormented him was Alice’s request for an emergency electroencephalogram with neurological consult. He knew that was out of the ordinary for someone with a run-of-the-mill cardiac arrest and receiving CPR.

At the ED receiving bay, a group of doctors, nurses, and orderlies, all in full personal protective gear and face shields, were waiting, including a rugged-looking, slim, white-haired man and the ranking emergency physician on the shift, Dr. Theodore Hard. By the time Brian had quickly climbed out of the ambulance’s cab, Emma was already on her way inside with the Lucas apparatus pumping and Alice still respiring her with the ambu breathing bag. Brian had to run to catch up. He knew he probably wasn’t supposed to follow, but he did anyway, and in the commotion, no one questioned his presence despite the fact that he was the only person without an impermeable protective gown and face shield.

The entire group raced into one of the Level 1 trauma rooms, where Emma was transferred from the ambulance gurney to the table. Brian stayed in the background while Dr. Hard yelled orders to set up an ECG, place an oximeter, and start an intravenous even though the tibial cannula was still in place. The oximeter gave a reading of 95 percent, suggesting that the CPR had been effective. The moment the electrocardiogram blip appeared, tracing across the monitor, everyone could see there was electrical activity, but it was obviously not normal. It was also quickly determined that when the Lucas was switched off, there was no pulse and no blood pressure. Instantly they reinstated CPR with manual compressions while Alice, who had not stopped using the ambu bag, quickly summarized for Dr. Hard what had happened in the victim’s home and in the ambulance, listing the medications that had been given and the approximate duration of the initial seizure. She made a point of emphasizing how cyanotic the patient had been, and then described how surprised she was to be confronted with pulseless electrical activity after the second seizure and what she thought it meant.

“I think you are probably correct,” Dr. Hard said. He’d been nodding as Alice had related what they’d done. After Alice finished her rapid synopsis, he took a small penlight from his pocket, bent over, and checked Emma’s pupils. “Uh-oh! No reaction whatsoever,” he stated as he straightened upright. “That’s not encouraging, to say the least. It suggests no brain stem reflexes. Okay! Let’s get the neuro guys down here and do an emergency electroencephalogram. Meanwhile, continue the CPR and draw blood for electrolytes, glucose, and troponin just to be sure.”

As the only person in normal street clothes, Brian felt that he stood out like a sore thumb and was expecting to be asked to leave at any moment. Taking advantage of a new flurry of activity, enacting Dr. Hard’s latest orders, Brian glanced around the trauma room, quickly spotting a long, white doctor’s coat hanging on the back of a door. Trying not to garner attention, he walked over, lifted the coat from its hook, and slipped it on. It was unreasonably snug, but he couldn’t be choosy. He was aware there was a name tag, but he couldn’t make it out upside down. So attired, he felt considerably less out of place and only hoped no one asked him any difficult medical question, which would surely expose him as an outsider.

A few minutes later Alice and George informed Dr. Hard they had to call in their home base and be available for their next run. After they’d gathered their belongings and said goodbye to all, George recognized Brian despite the white coat and approached.

“Wait a minute, are you a doctor?” George asked, momentarily confused. He leaned forward and read the name tag on Brian’s doctor’s coat. “Dr. Janice Walton? I don’t think so. I’m sorry, but you really shouldn’t be in here.”

Brian started to desperately explain that he needed to be with his wife.

“Sorry,” George repeated. “I can only imagine how wrenching this must be for you, but you aren’t allowed back here.” He called out to one of the ED nurses named Tamara Reyes, who came over immediately. George explained that Brian was Mr. Murphy, the patient’s husband.

“Good lord! Have you been watching all this?” Tamara said, eyeing him as he struggled out of the doctor’s coat and returned it to its hook. “You poor, poor man. How did you get in here? Oh, never mind. Follow me! I’ll take you out to the lobby. You should have gone out there to sign in your wife.”

Resigned to having been discovered and mildly surprised he’d managed to stay undetected as long as he had, Brian followed Tamara. Out in the lobby there was a line of people waiting to check in, but Tamara ignored them and called out to one of the clerks. She introduced Brian as Mr. Murphy, the husband of the CPR victim, and told her to get all the info and a signed release pronto.

For the next fifteen minutes he gave all the usual information, including the Peerless policy number. As he did so, he wondered how Peerless might try to evade covering this emergency visit since Emma certainly hadn’t walked in. He also wondered if the hospital computer would immediately spit out that he owed the institution almost two hundred thousand dollars when the clerk entered his name. If it had, the clerk didn’t let on. After Brian signed what he needed to sign, he was free to find a place to sit. He chose a spot at the far end of the room, as far as possible from any other people.

Time dragged. Minutes seemed like hours. At one point he took out his phone to call home, more just to connect than anything else since he didn’t have anything yet to report. As he held his phone, he noticed his hand was trembling. Try as he might, he couldn’t stop it, and he realized it was because every muscle in his body was contracted. Changing his mind about calling anyone, he used his phone to check his email, but he did so with unseeing eyes. He couldn’t concentrate. What he was really attempting to do was occupy his mind so as not to think about what was going on back in the trauma room, yet it was impossible. In his mind’s eye he kept seeing the horrifying image of Emma being given CPR. From his EMT training and experience as a police officer, he knew all too well what that could mean if the patient didn’t respond immediately.

In an attempt to avoid thinking the worst, Brian let his eyes wander around the ED waiting room. It was moderately busy as per usual. In contrast to him, no one seemed to be in an agitated state, which only made him feel worse. Then he suddenly saw Dr. Hard, who had just materialized from the depths of the Emergency Department. The doctor paused, and after a moment surveying the room, his eyes locked on to Brian’s. He then immediately headed in his direction with a determined stride.

Assuming the man was coming to see him, Brian quickly rose to his feet. As the doctor approached, Brian’s mind, which was trying desperately to divert his attention away from reality, decided that without his protective gown and with his lean and lanky body the man looked more like a cowboy hero in an old Western movie than a doctor in a New York City Emergency Department. Yet, unfortunately, he didn’t appear as if he was coming to save the day. With his mask covering most of his face, Brian couldn’t see the man’s expression, but the way he was walking suggested a disturbing gravity. Fearing the worst, he tried to steel himself.

Dr. Hard stopped six feet away. “Are you Brian Murphy, husband of Emma Murphy?” he asked. He spoke with an aura of seriousness and empathy that cut to the chase.

“I am,” Brian managed. His throat had gone bone dry.

“I’m afraid I have very bad news for you,” Dr. Hard said. “Would you please come with me?”