Hold Tight
Chapter 8
DANTE Loriman came into Ilene Goldfarb's office first. He gave Mike a little too firm a handshake. Susan came in behind him. Ilene Goldfarb stood and waited behind her desk. She had the glasses back on now. She reached across and gave them both quick handshakes. Then she sat down and opened the manila folder in front of her.
Dante sat next. He never looked at his wife. Susan took the chair next to him. Mike stayed in the back of the room, out of sight. He folded his arms and leaned against the wall. Dante Loriman began carefully to roll up his sleeves. First the right sleeve, then the left. He placed his elbows on his thighs and seemed to beckon Ilene Goldfarb to hit him with the worst.
"So?" Dante said.
Mike watched Susan Loriman. Her head was up. She sat hold-your-breath still. Too still. As if feeling his gaze, Susan turned her lovely face toward him. Mike aimed for neutral. This was Ilene's show. He was just a spectator.
Ilene continued to read the file, though that seemed more for show. When she was done, she folded her hands on the desk and looked somewhere between the two parents.
"We ran the necessary tissue typing tests," she began.
Dante interrupted. "I want to be the one."
"Excuse me?"
"I want to give Lucas a kidney."
"You're not a match, Mr. Loriman."
Just like that.
Mike kept his eyes on Susan Loriman. Now it was her turn to play neutral.
"Oh," Dante said. "I thought the father..."
"It varies," Ilene said. "There are many factors, as I think I explained to Mrs. Loriman during her previous visit. Ideally we want the HLA typing to have a six antigen match. Based on the HLA typing, you wouldn't be a good candidate, Mr. Loriman."
"How about me?" Susan asked.
"You're better. You're not perfect. But you're a better match. Normally your best chance is a sibling. Each child inherits half his antigens from each parent and there are four combinations of inherited antigens possible. Put simply, a sibling has a twenty-five percent chance of being an identical match, a fifty percent chance of being a half match-a three antigen-and a twenty-five percent chance of not being a match at all."
"And which is Tom?"
Tom was Lucas's younger brother.
"Unfortunately, the news is bad there. Your wife is the best match we have so far. We will also put your son on the cadaver kidney transplant bank, see if we can find a better candidate, but I would call that unlikely. Mrs. Loriman might be considered good enough, but frankly she is not an ideal donor."
"Why not?"
"Her match is a two. The closer we are to a six, the more likely your son's body will not reject the new kidney. You see, the better the antigen match, the less likely he will have to spend his life taking medications and doing constant dialysis."
Dante ran his hand through his hair. "So what do we do now?"
"We have a little time maybe. Like I said, we can put his name on the list. We search and keep working with dialysis. If nothing better comes along, we use Mrs. Loriman."
"But you'd like to find better," Dante said.
"Yes."
"We have some other relatives who said they'd donate to Lucas if they could," Dante said. "Maybe you could test them."
Ilene nodded. "Make up a list-names, addresses, and exactly how they are blood related."
Silence.
"How sick is he, Doc?" Dante spun around and looked behind. "Mike? Be straight with us. How bad is this?"
Mike looked at Ilene. Ilene gave a little go-ahead nod.
"Bad," Mike said.
He looked at Susan Loriman when he said it. Susan looked away. They discussed options for another ten minutes or so and then the Lorimans left. When Mike and Ilene were alone, Mike took the chair Dante had been in and raised his palms to the sky. Ilene pretended to be busy putting files away.
"What gives?" Mike said.
"You thought I should tell them?"
Mike didn't reply.
"My job is to treat their son. He is my patient. The father isn't."
"So the father has no rights here?"
"I didn't say that."
"You took medical tests. You learned something from them that you kept from a patient."
"Not my patient," Ilene countered. "My patient is Lucas Loriman, the son."
"So we bury what we know?"
"Let me ask you this. Suppose I found out from some test that Mrs. Loriman was cheating on Mr. Loriman, would I be obligated to tell him?"
"No."
"How about if I found out that she was dealing drugs or stealing money?"
"You're reaching, Ilene."
"Am I?"
"This isn't about drugs or money."
"I know, but in both cases it is irrelevant to the health of my patient."
Mike thought about that. "Suppose you found a medical problem in Dante Loriman's test. Suppose you found out that he had a lymphoma. Would you tell him?"
"Of course."
"But why? As you just pointed out, he's not your patient. He's not your concern."
"Come on, Mike. That's different. My job is to help my patient- Lucas Loriman-get better. Mental health is part of that. Before we do a transplant, we make our patients go through psychiatric counseling, right? Why? Because we worry about their mental health in these situations. Causing tremendous upheaval in the Loriman household will not benefit my patient's health. Period, end of story."
They both took a second.
"It's not that easy," Mike said.
"I know."
"This secret will weigh heavy on us."
"That's why I shared it with you." Ilene spread her arms and smiled. "Why should I be the only one with sleepless nights?"
"You're a great partner."
"Mike?"
"Yes?"
"If it was you, if I ran a test like this and found out that Adam wasn't your biological son, would you want to know?"
"Adam not my son? Have you seen the size of his ears?"
She smiled. "I'm trying to make a point. Would you want to know?"
"Yes."
"Just like that?"
"I'm a control freak. You know that. I need to know everything."
Mike stopped.
"What?" she said.
He sat back, crossed his legs. "Are we going to keep avoiding the elephant in the room?"
"That was my plan, yes."
Mike waited.
Ilene Goldfarb sighed. "Go ahead, say it."
"If our first credo is indeed 'First do no harm'..."
She closed her eyes. "Yeah, yeah."
"We don't have a good donor for Lucas Loriman," Mike said. "We're still trying to find one."
"I know." Ilene closed her eyes and said, "And the most obvious candidate would be the biological father."
"Right. He's our best chance now for a solid match."
"We need to test him. That's priority one."
"We can't bury it," Mike said. "Even if we want to."
They took that in.
"So now what do we do?" Ilene asked.
"I'm not sure we have much of a choice."
BETSY Hill waited to confront Adam in the high school parking lot.
She looked behind her at "Mom Row," the curb along Maple Avenue where the moms-yes, there was the occasional dad but that was more the exception that proved the rule-sat in idling cars or gathered to chat with other moms, waiting for school to let out so they could shepherd their offspring to the violin lesson or the orthodontist appointment or the karate class.
Betsy Hill used to be one of those mothers.
She had started as one of those mothers at the kindergarten drop-off at Hillside Elementary and then middle school at Mount Pleasant and finally here, just twenty yards from where she now stood. She remembered waiting for her beautiful Spencer, hearing the bell, peering out the windshield, watching the kids erupt-exit like ants scattering after a human boot toes their hill. She'd smile when she first laid eyes on him and most of the time, especially in the early days, Spencer would smile back.
She missed being that young mother, the naivete you are granted with your firstborn. It was different now, with the twins, even before Spencer's death. She looked back at those mothers, at the way they did it without a care or thought or fear, and she wanted to hate them.
The bell sounded. The doors opened. The students made their way out in giant waves.
And Betsy almost started looking for Spencer.
It was one of those brief moments when your brain just can't go there anymore, and you forget how horrible everything is now, and you think, for just a brief second, that it was all a bad dream. Spencer would walk out, his backpack on one shoulder, his posture in teenage stoop, and Betsy would see him and think that he needed a hair-cut and looked pale.
People talk about the stages of grief-denial, anger, bargaining, depression, acceptance-but those stages tend to blend more in tragedy. You never stop denying. Part of you is always angry. And the whole idea of "acceptance" is obscene. Some shrinks prefer the word "resolution." Semantically the notion was better, but it still made her want to scream.
What exactly was she doing here?
Her son was dead. Confronting one of his friends would not change that.
But for some reason it felt like it might.
So maybe Spencer hadn't been alone that whole night. What did that change? Cliche, yes, but it wouldn't bring him back. What was she hoping to find here?
Resolution?
And then she spotted Adam.
He was walking alone, the backpack weighing him down-weigh- ing them all down, when she thought about it. Betsy kept her eyes on Adam and moved right so that she would be in his path. Like most kids, Adam walked with his eyes down. She waited, adjusting her stance a little left or right, making sure that she stayed in front of him.
Finally, when he got close enough, she said, "Hi, Adam."
He stopped and looked up. He was a nice-looking boy, she thought. They all were at this age. But Adam too had changed. They had all crossed some adolescent line. He was big now, tall with muscles, much more a man than a boy. She could still see the child in his face, but she could also see something like a challenge too.
"Oh," he said. "Hi, Mrs. Hill."
Adam started to walk away, now veering toward his left.
"Can I talk to you a moment?" Betsy called out.
He glided to a stop. "Uh, sure. Of course."
Adam jogged toward her with athletic ease. Adam had always been a good athlete. Not Spencer. Had that been part of it? Life is so much easier in towns like this when you're a good athlete.
He stopped maybe six feet in front of her. He couldn't meet her eye, but few high school boys could. For a few seconds she did not say anything. She just looked at him.
"You wanted to talk to me?" Adam said.
"Yes."
More silence. More staring. He squirmed.
"I'm really sorry," he said.
"About?"
That answer surprised him.
"About Spencer."
"Why?"
He didn't reply, his eyes everywhere but on her.
"Adam, look at me."
She was still the adult; he was still the kid. He obeyed.
"What happened that night?"
He swallowed and said, "Happened?"
"You were with Spencer."
He shook his head. His face drained of color.
"What happened, Adam?"
"I wasn't there."
She held up the picture from the MySpace page, but his eyes were back on the ground.
"Adam."
He looked up. She thrust the picture toward his face.
"That's you, isn't it?"
"I don't know, it might be."
"This was taken the night he died."
He shook his head.
"Adam?"
"I don't know what you're talking about, Mrs. Hill. I didn't see Spencer that night."
"Look again-"
"I have to go."
"Adam, please-"
"I'm sorry, Mrs. Hill."
He ran away then. He ran back toward the brick edifice and around the back and out of sight.
Dante sat next. He never looked at his wife. Susan took the chair next to him. Mike stayed in the back of the room, out of sight. He folded his arms and leaned against the wall. Dante Loriman began carefully to roll up his sleeves. First the right sleeve, then the left. He placed his elbows on his thighs and seemed to beckon Ilene Goldfarb to hit him with the worst.
"So?" Dante said.
Mike watched Susan Loriman. Her head was up. She sat hold-your-breath still. Too still. As if feeling his gaze, Susan turned her lovely face toward him. Mike aimed for neutral. This was Ilene's show. He was just a spectator.
Ilene continued to read the file, though that seemed more for show. When she was done, she folded her hands on the desk and looked somewhere between the two parents.
"We ran the necessary tissue typing tests," she began.
Dante interrupted. "I want to be the one."
"Excuse me?"
"I want to give Lucas a kidney."
"You're not a match, Mr. Loriman."
Just like that.
Mike kept his eyes on Susan Loriman. Now it was her turn to play neutral.
"Oh," Dante said. "I thought the father..."
"It varies," Ilene said. "There are many factors, as I think I explained to Mrs. Loriman during her previous visit. Ideally we want the HLA typing to have a six antigen match. Based on the HLA typing, you wouldn't be a good candidate, Mr. Loriman."
"How about me?" Susan asked.
"You're better. You're not perfect. But you're a better match. Normally your best chance is a sibling. Each child inherits half his antigens from each parent and there are four combinations of inherited antigens possible. Put simply, a sibling has a twenty-five percent chance of being an identical match, a fifty percent chance of being a half match-a three antigen-and a twenty-five percent chance of not being a match at all."
"And which is Tom?"
Tom was Lucas's younger brother.
"Unfortunately, the news is bad there. Your wife is the best match we have so far. We will also put your son on the cadaver kidney transplant bank, see if we can find a better candidate, but I would call that unlikely. Mrs. Loriman might be considered good enough, but frankly she is not an ideal donor."
"Why not?"
"Her match is a two. The closer we are to a six, the more likely your son's body will not reject the new kidney. You see, the better the antigen match, the less likely he will have to spend his life taking medications and doing constant dialysis."
Dante ran his hand through his hair. "So what do we do now?"
"We have a little time maybe. Like I said, we can put his name on the list. We search and keep working with dialysis. If nothing better comes along, we use Mrs. Loriman."
"But you'd like to find better," Dante said.
"Yes."
"We have some other relatives who said they'd donate to Lucas if they could," Dante said. "Maybe you could test them."
Ilene nodded. "Make up a list-names, addresses, and exactly how they are blood related."
Silence.
"How sick is he, Doc?" Dante spun around and looked behind. "Mike? Be straight with us. How bad is this?"
Mike looked at Ilene. Ilene gave a little go-ahead nod.
"Bad," Mike said.
He looked at Susan Loriman when he said it. Susan looked away. They discussed options for another ten minutes or so and then the Lorimans left. When Mike and Ilene were alone, Mike took the chair Dante had been in and raised his palms to the sky. Ilene pretended to be busy putting files away.
"What gives?" Mike said.
"You thought I should tell them?"
Mike didn't reply.
"My job is to treat their son. He is my patient. The father isn't."
"So the father has no rights here?"
"I didn't say that."
"You took medical tests. You learned something from them that you kept from a patient."
"Not my patient," Ilene countered. "My patient is Lucas Loriman, the son."
"So we bury what we know?"
"Let me ask you this. Suppose I found out from some test that Mrs. Loriman was cheating on Mr. Loriman, would I be obligated to tell him?"
"No."
"How about if I found out that she was dealing drugs or stealing money?"
"You're reaching, Ilene."
"Am I?"
"This isn't about drugs or money."
"I know, but in both cases it is irrelevant to the health of my patient."
Mike thought about that. "Suppose you found a medical problem in Dante Loriman's test. Suppose you found out that he had a lymphoma. Would you tell him?"
"Of course."
"But why? As you just pointed out, he's not your patient. He's not your concern."
"Come on, Mike. That's different. My job is to help my patient- Lucas Loriman-get better. Mental health is part of that. Before we do a transplant, we make our patients go through psychiatric counseling, right? Why? Because we worry about their mental health in these situations. Causing tremendous upheaval in the Loriman household will not benefit my patient's health. Period, end of story."
They both took a second.
"It's not that easy," Mike said.
"I know."
"This secret will weigh heavy on us."
"That's why I shared it with you." Ilene spread her arms and smiled. "Why should I be the only one with sleepless nights?"
"You're a great partner."
"Mike?"
"Yes?"
"If it was you, if I ran a test like this and found out that Adam wasn't your biological son, would you want to know?"
"Adam not my son? Have you seen the size of his ears?"
She smiled. "I'm trying to make a point. Would you want to know?"
"Yes."
"Just like that?"
"I'm a control freak. You know that. I need to know everything."
Mike stopped.
"What?" she said.
He sat back, crossed his legs. "Are we going to keep avoiding the elephant in the room?"
"That was my plan, yes."
Mike waited.
Ilene Goldfarb sighed. "Go ahead, say it."
"If our first credo is indeed 'First do no harm'..."
She closed her eyes. "Yeah, yeah."
"We don't have a good donor for Lucas Loriman," Mike said. "We're still trying to find one."
"I know." Ilene closed her eyes and said, "And the most obvious candidate would be the biological father."
"Right. He's our best chance now for a solid match."
"We need to test him. That's priority one."
"We can't bury it," Mike said. "Even if we want to."
They took that in.
"So now what do we do?" Ilene asked.
"I'm not sure we have much of a choice."
BETSY Hill waited to confront Adam in the high school parking lot.
She looked behind her at "Mom Row," the curb along Maple Avenue where the moms-yes, there was the occasional dad but that was more the exception that proved the rule-sat in idling cars or gathered to chat with other moms, waiting for school to let out so they could shepherd their offspring to the violin lesson or the orthodontist appointment or the karate class.
Betsy Hill used to be one of those mothers.
She had started as one of those mothers at the kindergarten drop-off at Hillside Elementary and then middle school at Mount Pleasant and finally here, just twenty yards from where she now stood. She remembered waiting for her beautiful Spencer, hearing the bell, peering out the windshield, watching the kids erupt-exit like ants scattering after a human boot toes their hill. She'd smile when she first laid eyes on him and most of the time, especially in the early days, Spencer would smile back.
She missed being that young mother, the naivete you are granted with your firstborn. It was different now, with the twins, even before Spencer's death. She looked back at those mothers, at the way they did it without a care or thought or fear, and she wanted to hate them.
The bell sounded. The doors opened. The students made their way out in giant waves.
And Betsy almost started looking for Spencer.
It was one of those brief moments when your brain just can't go there anymore, and you forget how horrible everything is now, and you think, for just a brief second, that it was all a bad dream. Spencer would walk out, his backpack on one shoulder, his posture in teenage stoop, and Betsy would see him and think that he needed a hair-cut and looked pale.
People talk about the stages of grief-denial, anger, bargaining, depression, acceptance-but those stages tend to blend more in tragedy. You never stop denying. Part of you is always angry. And the whole idea of "acceptance" is obscene. Some shrinks prefer the word "resolution." Semantically the notion was better, but it still made her want to scream.
What exactly was she doing here?
Her son was dead. Confronting one of his friends would not change that.
But for some reason it felt like it might.
So maybe Spencer hadn't been alone that whole night. What did that change? Cliche, yes, but it wouldn't bring him back. What was she hoping to find here?
Resolution?
And then she spotted Adam.
He was walking alone, the backpack weighing him down-weigh- ing them all down, when she thought about it. Betsy kept her eyes on Adam and moved right so that she would be in his path. Like most kids, Adam walked with his eyes down. She waited, adjusting her stance a little left or right, making sure that she stayed in front of him.
Finally, when he got close enough, she said, "Hi, Adam."
He stopped and looked up. He was a nice-looking boy, she thought. They all were at this age. But Adam too had changed. They had all crossed some adolescent line. He was big now, tall with muscles, much more a man than a boy. She could still see the child in his face, but she could also see something like a challenge too.
"Oh," he said. "Hi, Mrs. Hill."
Adam started to walk away, now veering toward his left.
"Can I talk to you a moment?" Betsy called out.
He glided to a stop. "Uh, sure. Of course."
Adam jogged toward her with athletic ease. Adam had always been a good athlete. Not Spencer. Had that been part of it? Life is so much easier in towns like this when you're a good athlete.
He stopped maybe six feet in front of her. He couldn't meet her eye, but few high school boys could. For a few seconds she did not say anything. She just looked at him.
"You wanted to talk to me?" Adam said.
"Yes."
More silence. More staring. He squirmed.
"I'm really sorry," he said.
"About?"
That answer surprised him.
"About Spencer."
"Why?"
He didn't reply, his eyes everywhere but on her.
"Adam, look at me."
She was still the adult; he was still the kid. He obeyed.
"What happened that night?"
He swallowed and said, "Happened?"
"You were with Spencer."
He shook his head. His face drained of color.
"What happened, Adam?"
"I wasn't there."
She held up the picture from the MySpace page, but his eyes were back on the ground.
"Adam."
He looked up. She thrust the picture toward his face.
"That's you, isn't it?"
"I don't know, it might be."
"This was taken the night he died."
He shook his head.
"Adam?"
"I don't know what you're talking about, Mrs. Hill. I didn't see Spencer that night."
"Look again-"
"I have to go."
"Adam, please-"
"I'm sorry, Mrs. Hill."
He ran away then. He ran back toward the brick edifice and around the back and out of sight.
