By Kathleen Dickerson
Abigail finds it easier to navigate this hospital visit knowing it’s almost her last. No more long drives to pick up her father. No more missed work. No more sick people and sad family members shuffling past her in the dim corridor.
As they approach the end of the hallway, Peter turns to her. “Should we take the elevator?”
She pushes aside her sketchbook and finds her wallet, only to discover she used the last cash she had on parking, even though she left her car in the furthest—and cheapest—zone. “Maybe we should take the stairs.” She looks down as she speaks, avoiding her father’s eyes.
“Abigail,” he says, “we’re at the hospital. It’s free here.”
She forgets this every time. Almost everywhere else, the elevator requires a small fee. Like her apartment building. She lives on the fourth floor and always takes the stairs, which she doesn’t mind. A short climb is good for her. It gives her some time to herself.
Between the open cubicle at her big data job, the four-person carpool into the office, and the three-bedroom apartment she shares with five others, Abigail never gets to be alone. She constantly craves privacy.
As they wait for the elevator, Abigail stares at her father. He has gotten thin. His sticklike arms poke out from his t-shirt. The fat has disappeared from his face, leaving his cheeks hanging like jowls. But his stomach has gone in the other direction; while everything else shrank, it protrudes over his belt, engulfing the buckle.
Abigail should be excited for her father, for his last treatment, but mostly she thinks about herself and her imminent freedom. With all the time she took off to take Peter to his appointments and all her subsequent lost wages, Abigail had to postpone her move. Now that they’re nearing the end, Abigail can look at her father’s illness as a small obstacle in her plan.
When she started at the big data firm, she cleaned for minimum wage. Now, as one of the manager’s assistants, her pay has nearly doubled and she can afford a studio apartment. It costs a little more than she was hoping to spend, but she has calculated it: if she never misses a day of work, maybe picks up an extra shift or two, she can afford it. The overtime will be worth it if she can come home everyday to a private place, a place all her own.
Peter looks at his daughter, whose eyes are fixed on the elevator. It’s hard for him to believe how fully Abigail has embraced new rules, rules that still feel so foreign to him.
She treats the elevator like some kind of reward, a privilege she hasn’t earned, but he knows better. He can still remember a time all elevators—and water fountains and public restrooms—were free.
It’s not even a nice elevator, he decides, turning his attention to the doors as they ding open. Inside, the button numbers are faded. The floor is a light brown he’s pretty certain used to be white, and it’s covered in scoff marks from shoes and wheelchairs.
In fact, the whole hospital is sub-par at best. His appointments always take longer than they should, the place isn’t clean, and Dr. Cuthbert doesn’t even have his credentials on his business card, which Peter initially found off-putting. There are other average hospitals within twenty miles of his house. He could try another one, see if they have shorter wait times or friendlier doctors or less expensive services. He always has the choice to switch. Choice empowers the people, he catches himself thinking. Damn advertisements.
There’s no reason to change to another mediocre place. The service would likely be the same, and at least this hospital has Colleen. The first time he came here for his procedure, when she held his hand and locked her big blue eyes with his, he decided to stick with F.A. Hayek.
The elevator dings again, and when the doors open to the Gastroenterology and Hepatology Ward, Colleen waits there to greet them.
“Hi Peter!” She grabs his arm to escort him towards the desk. “Right on time, as always. How are you feeling today?”
Abigail rushes ahead to scan the desk for her father’s charts. She likes to preview them, to learn what each visit will entail so she can prepare herself before Colleen informs her. This is his last round of parecentesis—he gets his liver transplant next week—and she wants to know if anything will be different.
Most days, the easiest days, it’s just the draining. One hour. In and out. Then she is free to go. But once, a few months earlier, before she started previewing the charts, the hospital scheduled Peter for a colonoscopy. The whole ordeal took three additional hours, and Abigail showed up late for her half-day of work. She called her boss and offered the situation as an explanation but not an excuse, worried about losing her job. Peter must’ve overheard the conversation, because he apologized more than usual on the car ride home.
Today, under Peter Byrne, the notes look long. The doctor’s written them, she assumes. They’re not in Colleen’s loopy handwriting. She can only make out two things: MELD and 32.
Abigail was never a great student. She couldn’t retain the information she tried to memorize. But she has come to learn—and remember—a great deal about Model for End-Stage Liver Disease. When she first heard about her father’s condition, she researched it, looking up any words she didn’t know and reading some of the articles three or four times to make sure she understood their contents. The thirty-two on her father’s chart, she understands, is well above the danger zone score of twenty-five.
By the time she looks up from the chart, Colleen and Peter have bypassed her and entered his room. Number three, every time. He doesn’t pay extra to get a private room so close to the nurse’s station—at least, not that Abigail knows. He couldn’t afford it. It must be Colleen’s work. They are indebted to her for this rare gift, this added layer of comfort and safety.
Abigail enters the room just in time to see Peter swing his left leg onto the bed.
“You’re becoming quite the parecentesis expert,” Colleen teases. “Excited to get those fluids out?”
“Fluids? I climbed up here because I thought you were joining me.” He pats the bed and lets out a chuckle. His laughs are getting weaker, Abigail can tell.
“You’re too much, Peter.”
He’s always joked like this, even since he stopped drinking. The gregariousness he developed in those years, much like the cirrhosis, seems here to stay.
For a long time, Abigail didn’t think about her father’s drinking days. Then Jack moved into the apartment. When she sees Jack, dazed and lost in the expensive cable television—television she needs to pay a sixth of the bill for though she never watches it—she can’t help but remember her father in the same position. When she hears Jack on the phone screaming at his girlfriend, she can picture her mother slumped over the kitchen table, defeated. At times like these, it all comes back to her.
Dr. Cuthbert shows up and interrupts her thoughts. “Any changes since you were here last?” he asks Peter without greeting.
“Alright,” he says. Colleen scribbles something on his chart. “Let’s get started then.”
Peter pulls up his shirt, exposing the left side of his bloated gut, as Dr. Cuthbert pours the contents of an unlabeled container onto a piece of gauze. Abigail tries to determine the color: not quite brown, not quite red. There’s a name for it, she knows—she can picture a crayon of the same color, one that used to live in the Crayola 64 pack assigned to each group at her first school, the school she attended before Peter lost his job. Maroon? Mahogany? Caramel? Copper?
Burnt sienna, she decides, proud to have remembered the term. It’s been almost a decade since she’d seen that crayon, that label. Her second school didn’t carry Crayola, just unwrapped, unnamed bits of wax.
Dr. Cuthbert rubs the gauze on Peter’s stomach in small, circular, tender movements, leaving a ring of the burnt sienna liquid.
Abigail watches as he draws out the first needle. It’s the longest needle she’s ever seen, though she hasn’t seen many, and it still makes her flinch every time. Abigail turns away when the tip makes contact with her father’s belly.
Peter knows how much Abigail hates being at the hospital. He notices her cringe at the sight of the needle. He can tally the wages she loses when she misses a day of work. He knows how hard she works to save up for a place of her own. But he can’t bring himself to the hospital. Not anymore, not without a car, even if they would let him walk out alone after his procedure.
Once, he tried to tell her how things used to be. He explained how his own father’s job covered a check-up every year for Peter and his siblings. He talked about the time he knocked out his front tooth playing baseball, and how his father’s insurance paid for the cap.
But Abigail couldn’t comprehend the idea a company would offer insurance to its employees. She doesn’t remember how—up until the U.S. Post Office was disassembled—Peter’s job paid for Abigail’s healthcare costs. She was four then. Of course she wouldn’t remember.
It all went downhill so quickly after that year. First the businesses. Then the schools. The public safety organizations and libraries followed. All of it, privatized. Deregulate the market. Reempower the people. The first time Peter heard the slogan, he was in the car, driving to pick up Abigail from preschool.
Sitting on the hospital bed, the needle poking out from his already protruding stomach, Peter laments the loss of that job. He still regrets he never found a comparable one, though he tried his best. He’d applied with Fed Ex, with UPS. But neither wanted him. He suspected it was his age. Poor return on investment.
There were a few things he’d done right, though. When they cashed out the pensions, he knew enough to tuck his money away, to save it for a predicament just like this one. And he got a job at the university two towns over, the one he’d wanted Abigail to attend. He thought he could see her sometimes. She might swing by the security desk where he checked IDs and say hello between classes.
She didn’t get in, of course. Almost no one from Abigail’s high school went to college. Moving her from her first school—one where almost half the students went somewhere, even the local university—was his biggest regret.
But no use dwelling on regrets now, especially today. His last parecentesis treatment. It was almost unbelievable, too good to be true. Doubts pushed their way to the forefront of his mind, awful, apocalyptic scenarios in which one of a dozen things prevented him from receiving a new, healthy liver. He replaced each such scenario with a positive one. Going back to work. Lending Abigail some money. Helping her move out of the slumlord’s apartment complex and into her own place. These are the thoughts that sustain him.
“Ow!” Peter yells.
Abigail jumps. “What? Are you okay?”
“Just kidding.” He laughs, and a small smile spreads across Colleen’s face. But Doctor Cuthbert remains expressionless. He’s desensitized to Peter by now.
They sit around waiting for Peter’s body to numb, and Colleen fills the silence. She talks about a TV show she knows Peter likes and takes out her phone to show them pictures of her new puppy.
Finally, Dr. Cuthbert asks, “Are you ready, Mr. Byrnes?” A formality. He’s already holding the next needle.
Peter nods, grabs Colleen’s hand, and closes his eyes.
Dr. Cuthbert hooks the end of the needle to the vacuum bottle hanging off Peter’s bed, and Abigail watches the liquid from her father’s body fill the bag. She mumbles a soft “excuse me” and slips out the door.
F. A. Hayek has a number of cafés, but Abigail prefers the one on the east side of the hospital, the one where she can pour the coffee herself. It’s an eight-minute walk from the Gastroenterology and Hepatology Ward. To get there, she needs to go to the front entrance and into another annex. She passes three other cafés on the way, all nicer—and more expensive—than the one she will settle on.
As she walks, Abigail counts the change in her bag. A handful of quarters have gathered at the bottom. It’s not a lot of money, but it can buy a small drink.
As Abigail considers the coins, a lump of guilt settles in her stomach. Even though it didn’t come to it, she was going to make her father take the stairs. She wasn’t going to use that change on him. She was going to watch as he dragged himself up, pulling on the railing, groaning with each step.
So, to keep her shame private, Abigail doesn’t take the money out of her purse. Instead, she counts with her fingertips, palming one coin at a time until she reaches the correct amount.
The café on the east side brims with people like her: other patients, mostly, and the occasional hospital employee. A janitor before his shift. A security guard on break. For the most part, they make good subjects. Their harrowed faces force her to capture lines and arcs unfamiliar to her.
During one of Peter’s first parecentesis appointments, Abigail holed up in the corner of this café and sketched everything: the plastic carafes on the little wooden cart, the line of antsy customers, the mismatches chairs awaiting them. She could have better shown how the chairs clashed if she used color, but color was not available to her. Any other tools—colored pencils, chalk, even markers—cost more than three times the price of her regular lead pencils. She was proud of it anyway and taped it up in the apartment.
That was one of her many sketches that got ruined a few weeks ago. Her roommates were always moving her things. One took her sketches down and piled them on the kitchen table. Then another—Jack, she thinks—used them as a coaster. The sweat from his beer bled all the way through, creating a blurry ring in the corner of every sketch on the table.
Maybe it’s for the best, she decides. She doesn’t need a memory of F.A. Hayek in her new apartment. She will line the walls with sketches of happier times. Maybe, in the future, even sketches in color. And no one else will be there to tear them down.
She savors her coffee and the quiet as long as she can before beginning the walk back to Peter’s room. When she returns to her father, the bag by his bed is almost full, but he’s still attached to it. She hates the liter of yellow-white pus. She hates seeing just how much has been taken out of his body, hates thinking about how it must’ve hurt to have it in there. She hates herself for returning too soon.
“Glad you’re back, Abigail,” Colleen says. “We just finished discussing next steps.”
“Yes,” Colleen answers. “How to prepare for the surgery. The fasting, the paperwork, all that. Your father will explain it to you.”
Abigail nods. Peter has been waiting for this transplant for a year and a half. The parecentesis has helped, but it’s a Band-Aid cure. It might sustain him for two years, three at most, before his liver would fail.
Abigail has been waiting for this, too. Her father’s new liver means no more day trips to the hospital, no more days off work. In fact, she has only scheduled two more days off after today: Thursday, Peter’s transplant, and Wednesday, moving day.
“So I’ll see you on the fourth,” Dr. Cuthbert says.
“The fourth?” Abigail asks. “I thought it was the fifth. I put it in for the fifth.” She considers all of the plans she has already made for the fourth, the friends she’d begged and bribed to help her carry her things to her new place, the van she already put a deposit on. “I, um—” She can’t ask the doctor to change the surgery date, so no other words emerge.
Her father looks down at the ground. “It’s okay if you can’t take me. I could take the bus. I could—”
“No, no—I can take you.”
Colleen nods and confirms the appointment into her tablet. It’ll be okay, she tells herself as she watches Dr. Cuthbert disassemble the needle. She will find a way to reschedule. Maybe she can transfer the deposit. She still has almost a week, after all.
When Doctor Cuthbert removes the final needle, he snaps off his gloves and leaves without a goodbye.
“Well Peter, you did great today. I’m glad you won’t be back, obviously, but I’m going to miss seeing you.”
Using the bed railing to pull himself up, Peter stands and hugs Colleen. “You made this the highlight of my week,” he says, pulling a card out of his coat pocket and handing it to her.
“What’s this? You’re so sweet. I hope you find a new highlight, and I hope it’s nowhere near the hospital. Best of luck with your surgery.” She flashes him her best hopeful smile.
They walk back down the stairs, back through the blinding hallways. Peter moves more slowly now; he always does after a draining. She places him on a bench under the big F. A. Hayek Hospital sign and leaves him there while she treks out to the car.
“Abigail,” he says a few minutes later while she’s buckling him in. “Thank you again for taking me today. I’m sorry you’ve had to do this for so long.”
She hates this part of the visit the most: after each parecentesis appointment, her father gets weepy. Emotional. He starts conversations she doesn’t want to have, conversations about things she doesn’t understand and things neither of them can change.
“Dad, it’s fine. Just c’mon. I’ve got to get home.”
“I know,” he says. “I know you work so hard. And I really appreciate it. You come down here just for me. I know it’s an inconvenience. I know—”
She tries to focus on happier things, things to calm her down. Her new apartment. Space to spread out her sketches. A room of her own. “It’s fine, Dad. Just relax.”
“I know you’re worried about money,” he says, crying now. “And when I’m better, I can pick up some more shifts. I’ll help you. I can give you some money for rent, maybe even put some away for a down payment for your own house—”
She might laugh if she weren’t so upset. Home ownership was a dream for her father’s generation, but Abigail and her friends know better. Unless they inherit it, it is unlikely they’ll ever own a home.
It’s unreasonable for Abigail to resent Peter for all the things he could not give her. Objectively, she knows this. Emotionally, though, it doesn’t matter. And in this moment, she hates him for even mentioning an unattainable goal, a dream not worth considering.
She inhales and holds her breath in an attempt to control her anger. “Dad. Please just stop. I know you’re sorry. I get it. It doesn’t matter now anyway. One more appointment and you’re done. We’re done. So please, let’s talk about anything else.”
“I—” Peter says, then closes his mouth.
For twenty miles, neither of them speaks. Finally, Abigail turns on the radio to drown out the silence.
It plays for a few minutes before Peter’s phone vibrates, rattling against the console, and she turns the music down.
Her father clears his throat twice before he answers. “Hello? Oh, hi Doctor Cuthbert. Yes, we just left. Is everything okay?” Peter pauses for a long moment before he says, “I see. No—if that’s the way it works.”
Abigail half listens, repeating her calming thoughts from earlier. Her new apartment. Space to spread out her sketches. A room of her own.
“Do I still want to come in? On the sixth? For another round of parecentesis?” He glances at his daughter, waiting for her to confirm or deny her availability, and when she doesn’t respond, he says, “Abigail?”
“What? The sixth. Yeah.”
After Peter finishes his conversation, Abigail says, “Why’d they move your appointment?”
“They didn’t. That’s a different appointment.”
“Wait. Why do you need to be drained after the transplant?”
“I’m not getting the transplant,” he says, his voice quivering.
“What? Why not?”
“Someone moved to the top of the list.”
She remembered now that she’d read about this. Patients with really high MELD scores—higher than her father’s thirty-two—could get priority.
She wants to ask her father what this means for him, when another liver will be available, how long he can live seven points above the danger zone relying only on parecentesis. “That person must be doing really bad.”
“I don’t think so. I don’t think that’s what happened.”
“What? What happened then?”
“Someone paid extra.”
“Someone paid extra?”
Peter nods. “He didn’t tell me how much.”
“But you were next.”
From the corner of her eye, Abigail can see Peter force a smile. “At least I’ll still get to spend some time with Colleen.” He offers a faint laugh. “Maybe next month’ll be the month I finally win her over.”
“It’s not funny!” Abigail snaps at him. “How can they do this? Doctor Cuthbert said you were next.”
Peter doesn’t speak for a long time. When he does, he only mutters, “Deregulate the market. Reempower the people.”
Abigail doesn’t know what he’s talking about, and for a moment she considers he might be having some kind of mental break. The stress from the procedures is finally getting to him.
Usually, Peter tries not to be so cynical in front of his daughter, but he can’t censor himself this time. He almost wishes he could be as ignorant as she is. There’s comfort in ignorance, at least.
For years, he was able to tell himself it would be okay. When they moved to a less expensive neighborhood, he maintained it would be as safe as the place they were leaving. When, a few months later, he pulled Abigail out of her first school because he couldn’t afford all its fees, he convinced himself her education would still be sufficient.
This time, though, he couldn’t convince himself. He’d felt what was coming. From the moment Dr. Cuthbert put him on the list, he suspected someone with more influence, more power, more money would get the liver.
Peter looks at his daughter. She’s focusing on the road, and he can see the tears forming at the edges of her eyelids.
He knows she is crying for herself, for her small losses of time and privacy. She doesn't understand anything beyond that.
If he had known how things would turn out, he decides, he never would’ve had Abigail. What an awful time to raise a daughter. This unchecked power. This gross inequity. This biased system with its manipulative words. All along, false advertisement. Deregulate the people, they should’ve said. Reempower the marketplace.
Peter doesn’t know how he can explain all of this to Abigail, but he will have to find a way. It will be her problem soon enough.