It is a quarter past five on Tuesday morning as Sasha Trzynski treks down the snow-scraped sidewalks of 59th Street in Manhattan. Even for her it is unusually early. She’s already taken her son, Peter, to Mrs. Russo’s house and ridden an empty 4 train down from Mount Eden Avenue in the Bronx. As she passes the Christmas displays at Bloomingdale’s, she wonders what to buy her sister this year. A vendor rolls the guard up on his newsstand with a screech of metal, and she watches him beckon to the delivery truck easing backward down the quiet street. A man in a hazard-orange vest bends down from the truck with a fattened square of newspapers between his gloved hands and passes it to the vendor like a sacrament on Sunday, both routine and delicate. The two men, hands almost touching, talk with their fingertips. You got it? Great ghosts of exhaust steam up between them from the tailpipe of the truck. Yeah. I got it.
Sasha lets herself into Dr. Von Hatter’s office at Park Avenue Pathology. Before even turning on the fluorescent overhead lights, she crosses the room to boot up her decrepit computer. The monitor glows. Blue light shines through the burnt-in image of a patient record accidentally left on the screen over a long weekend ten years ago: Mr. Abraham Clemente. Dead six years now from the very prostate cancer the record indicates. Sasha hits the lights, hangs up her coat, and yanks off her salt-whitened boots before slipping into the sneakers from her bag. She makes the coffee, turns on the radio, and scrubs her hands with antibacterial soap. Snapping on a pair of white latex gloves, she opens the drawer containing the samples.
There are twenty-two today. Last week doctors all around the city delicately removed these slices of cyst and marrow and muscle. They bit away tiny segments of freckles, moles, and lymph nodes. Each half centimeter contains a thousand or so microscopic cells: a honeycomb of membranes that were once lungs, liver, or skin. The samples look innocuous enough, ordered in rows, already fixed by the weekend technician in 10 percent neutral buffered formalin, dehydrated in a series of concentrated ethanol baths, cleared with xylene, and finally infiltrated with paraffin and sliced so thin that light can pass through.
Twenty-two futures. Some are death sentences; others, full pardons. Some dictate life in a prison of chronic illness; others allow the possibility of parole. There are no minors in this court; all are tried as adults. For this last reason, mostly, Sasha does not often think about what the samples really are.
She submerges the slices in distilled water and stains them with hematoxylin. Then she has four minutes to kill, so she calls the doctor’s nighttime answering service to get his messages. The computer grunts suddenly, and the noise makes her heart squeeze for one quick extra beat. The thing always takes so long to boot up that she forgets she’s started it. Finished with the messages, she picks at a scab that she got on her knee while chasing Peter at Chuck E. Cheese’s last week. Sasha has to take Peter back there for another birthday party tonight, after work. Dr. Von Hatter has promised she can slip out early if she takes care of all the reports before he arrives at eight, which is why her morning has begun unusually early.
The four minutes now up, she runs the stained cells under tap water. Then a splash of 0.3 percent acid alcohol, more water, another wash in the bluing solution, followed by a final splash of water. All that remains is to add a few drops of eosin and sit back for two more minutes. A far-off crossing guard’s whistle signals to the Park Avenue parents bringing their children to the front doors of the Egan School across the street. They have before-school activities starting at 6 AM. Dr. Von Hatter said the Egan students have to keep up with the kids in Shanghai if they want to have a prayer of competing. Peter is too young still, but Sasha wants him to go to the Egan School and become a doctor someday. He could have his own office, even nicer than this one, and a beautiful wife, and then Sasha will be a grandmother and spend all day watching his children while Peter is at work, just like Mrs. Russo does for Sasha now.
Suddenly Sasha realizes more than two minutes have passed. The samples will be overexposed. She rushes across the room to wash away the eosin. If she messes up the slides, Dr. Von Hatter will make her redo them, all the way back to the formalin and the ethanol baths. She’ll have to stay late, and Peter will miss the birthday party. She squeezes her eyes shut and prays as the water flows over the samples. Why is life like this? So mindless, until one tiny lapse in attention ruins everything.
The samples are all right. Relieved, she begins pressing each one onto a slide for Dr. Von Hatter to analyze when he gets in. She works busily, thinking how close she came to ruining Peter’s evening. When she comes to the last sample, she lifts it up to the window. The sun is just beginning to come up behind the buildings to the east, and its pale rays shine through the tiny smear of blue and pink. Sasha reads the name on the coded strip at the end of the slide. This thousand-cell slice, this square half centimeter, is from a twenty-five-year-old named Irene Richmond.
Sasha has never met Irene Richmond. She does not know what this woman’s slide contains. That’s for Dr. Von Hatter to determine. Her only concern is that the slide has not been ruined, and so her day has not been ruined, and Peter will go to Chuck E. Cheese’s, and his face will light up like he’s at the pearly gates of heaven, though Peter doesn’t know about heaven yet, because Peter doesn’t know about Death yet, because Peter is just a little boy.
She returns to the sink and washes the blue dye off her latex gloves. It swirls into the basin, inky dark at first and then in lighter cerulean bands. Outside, the city is finally awake. Parents leave the Egan School and head to their offices or back to their apartments. The man on the corner is selling the newspapers from that morning’s bundles. Their pages are full of stories about politicians and criminals and movie stars and ballplayers. Someone died in a fire. Someone won the Powerball. Someone is being sued or heading to jail. None of these stories are about Irene Richmond, and none of them are about Sasha Trzynski. In all of the stories in all of the newspapers in the entire knotted, tragic, waking city, none are about anyone either of them has ever known.
Irene Richmond’s alarm goes off at eight, and she hits SNOOZE to buy herself another ten minutes, though this small movement immediately nixes any possibility of a real return to sleep. Resenting the yesterday self who set the alarm ten minutes earlier than was truly necessary, she sticks one foot out from under her blankets to confirm that, yes, it is still cold out there. Gathering the blanket around her, she rushes to the bathroom with her eyes closed and sets the shower as hot as it will go.
Will they call today? The doctor said middle of next week, and it is only Tuesday. Probably they meant Wednesday or even Thursday, or else they’d have said, “We’ll call first thing,” or, “We’ll call Tuesday.” So it’s tomorrow’s problem. If that, even. Today’s problem is whether there will be time to stop for coffee on the way to the art gallery. Sometimes there is coffee there, but when there isn’t, Irene’s morning is a horror show. Really she should have green tea instead. Antioxidants are better for you. But no. Today she needs more than better. She needs caffeine.
The issue with stopping for coffee is that she’ll have to carry the hot cup in one hand, and she’ll also have to carry the large portfolio folder that is currently on the bookshelf — You must not forget the folder on the bookshelf, she reminds herself — which contains the contracts Abeba needs for the commission.
Leaving the shower, Irene begins to make plans for the day. Once her hair is mostly dry and her clothes are on, she moves to the window, where she keeps her jewelry box inside a large brass birdcage hanging by a chain from the ceiling. It is the only decorative item she owns — she doesn’t count her own paintings, which stand facing the wall, like children who’ve been bad. The birdcage was left behind by the previous tenant. When the broker told her it came with the crumbling, fifth-floor walk-up, Irene signed the lease immediately.
She looks at her watch — her extra ten minutes have been squandered somewhere along the way, and now she has to hurry. If she gets to the studio late, she’ll have to have lunch late, which will mean being late to meet her friend, which will mean not having time to pick up the last few Christmas gifts she still needs to buy.
Don’t forget the folder, she reminds herself. Don’t forget it, don’t forget it, don’t forget it. She turns the command around in her head, like a sentence in a foreign-language lesson: By whom will the folder not be forgotten? The folder will not be forgotten by me. What is the thing which will not be forgotten by me? The thing which will not be forgotten by me is the folder. What will I not do to the folder? What I will not do to the folder is forget it.
Abeba is already upset with Irene about losing the Levy donation, which wasn’t Irene’s fault. Irene thinks Abeba is really angry because there’s going to be a feature about the gallery on the news — not the real news, but the news on those credit-card screens inside of cabs — and on the day the video producer came to shoot the gallery, Irene had, with Abeba’s complete permission, been storing one of her own paintings in the back room. And somehow the producer saw it and included it in the video, and now it turns out that the interview with Abeba has been trimmed to one banal line — “It’s an exciting time to be a young artist in New York City!” — lasting just four seconds, followed by a rather loving shot of Irene’s painting, which will be getting seven seconds of screen time. Tiny, cab-screen time. It is such bullshit, really, but Irene knows all it takes is one wrong step and Abeba will fire her, and it will be good-bye, salary and good-bye, benefits and good-bye, cramped, cold apartment. Irene doesn’t even take cabs usually.
Opening the tiny door to the birdcage, Irene rummages through the jewelry box until she locates two matching earrings. Then she holds her hair back with one hand and with the other pushes in the first earring while holding its mate in her clenched front teeth. She watches her mirror-self aim the slim metal post through the tiny hole, punched through her flesh by a Korean woman fifteen years ago (Christ!) during a back-to-school trip to the mall. Irene was ten. She remembers the way the dark-eyed woman rubbed her earlobe with a cold, wet cotton ball and how she pressed the piercing gun to the side of Irene’s head. There was a stabbing sensation, along with a sudden loneliness as the million other mall-goers instantly vanished and were replaced by blank and blinding pain — and then there was this dark-eyed Korean woman saying, “Shush.” Not making a shushing noise, but actually saying, “Shush.” The strangeness of this brought the whole world rushing back again.
Irene caps the first earring, holds back the hair on the opposite side of her head, and carefully moves the second earring from her teeth to her free hand, using her lips. As she does, she thinks about what might happen if, for some reason — an inopportune sneeze, a mouse running by, a car backfiring on Avenue A — she opened her mouth at that moment and the second earring tumbled back over her tongue and down into her esophagus.
Shit, she’s so late now. She closes the jewelry box and shuts the birdcage door too quickly; it swings wildly on its chain as she dashes out, nearly tripping over the most recent canvas she’s been working on (which already isn’t coming out the way she hoped). The birdcage is still swaying as she heads to the door — late, hair damp, and without coffee. At the last second she remembers and runs back for the folder on the bookshelf.
On his lunch break Dr. Von Hatter rockets around the bend at the bottom of Central Park on his Orbea Orca Aero M30 road bike, tucking his Giro-helmeted head to minimize air resistance. Not happy, he fights his way up Center Drive. This is his third lap around the park, and his pace is terrible. At 6.1 miles a lap, he is averaging a pathetic nineteen miles per hour. The speedometer indicates he is barely hitting thirty-five on the downhill stretches. His bicycle is top-of-the-line, weighing only seventeen pounds; Peter, his lab assistant’s eight-year-old, can lift it. Dr. Von Hatter’s racing suit is a scientifically designed, sweat-wicking blend of polyester and Lycra. He has been training for six weeks. And yet he still cannot keep up with the other racers in his 7 AM practice team. You’ll be in the C Group forever, his demons whisper over the radio in his earbuds. They’re a bunch of twenty- and thirty-year-olds! his wife’s scolding voice reminds him. You just turned sixty!
Don’t listen to her, he tells himself. You’re in the best shape of your life. You’re just getting started. Sixty isn’t what it used to be. People are already living to be a hundred, and in forty more years who knows what we’ll know? Dr. Von Hatter has always taken precautions. He eats well, filters his water, and uses an air purifier. He has never once held a cellular telephone up against either of his temporal lobes. His blood pressure is 100 over 70, and his resting heart rate is 62 bpm. He has always exercised: boxing in college, swimming with the kids when they were young, running when the weather was nice, walking with Alice after dinner to aid digestion. Now he sees that he’s wasted the better part of his six decades on earth rarely knowing the kind of adrenaline highs he experiences on a daily basis while cycling — the thudding of heart muscle against its cage of ribs, the sting of frigid air against the deepest bronchioles of his lungs, the springing throb of his abdominal muscles, which he feels protecting his organs as if surrounding them in iron.
Flying past the carousel, with the Sheep Meadow just ahead, Dr. Von Hatter thinks back on Mr. Kisor, a seventy-five-year-old patient who ran the New York City Marathon every year. Mr. Kisor had dared the doctor to run his first. Neither of them really expected Dr. Von Hatter to make it even halfway. In his practice runs he hardly ever got more than thirteen miles before throwing in the towel. But when the day of the race came, there in a crowd of thousands, the doctor found himself imbued with the resolve and resilience of a man half his age.
Already marathons are beneath him. There are only six months left before the triathlon: a one-mile swim down the Hudson River, a twenty-five-mile bike ride around the park (on this very route), and then a six-mile run back up the East Side to the starting line. He has to get his sorry ass out of the C Group if he wants to qualify. Alice is sure he is going to kill himself, but he is sure of just the opposite. This, he breathes, turning up toward the icy reservoir, this is how I’ll survive.
And it isn’t like he doesn’t know Death. He isn’t some fool teenager thinking he’ll live forever. He’s been a pathologist for thirty-five years: at Mount Sinai Hospital for a long time and now in private practice. No patients anymore, just a microscope. Staring into slides of blue-and-pink-stained universes — urine, blood, tissue. Flexible hours and a salary that allows for $3,100 racing bicycles and an apartment in Trump Place.
It sounds cold. He knows that. Most people don’t understand. Most people have never told twenty patients in a single day that they are going to die. That’s an honor pretty much reserved for wartime generals and pathologists. Most people will never see firsthand how a mother, spouse, or sibling reacts to such news. Helplessness makes monsters of people. He’s seen chairs thrown, exam tables kicked. The rooms pathologists speak to patients in now have everything bolted down. Even the patients who ought to expect the bad news can be dangerous. Once, he watched a woman who had survived fifty-seven years of alcoholism rip out a chunk of her own hair in fury when he told her she had liver cancer. A colleague of his, Dr. Matthews, got twelve stitches in his forehead after giving a diagnosis of leukemia. Leukemia! And not even in the incurable stage.
Still, it was the zen masters who spooked him the most: The mother of five young children who took the news of a certainly fatal pancreatic cancer without even a deep breath. The grizzled union man with mesothelioma so bad that his heart was practically encased in asbestos. The man who had masterfully ignored his steadily encroaching death for eight months before finally seeing a doctor, then just laughed and said, “You know, I always meant to take a hot-air balloon ride just once.” By that point the guy would have been lucky to ascend a stepladder.
Dr. Von Hatter pounds his $250 pedals past the silent boathouse and along a steady incline toward the rear of the Metropolitan Museum. A rainbow of Tiffany stained glass glints in the dull winter-noon light. I paid $3,100 for a bicycle, he likes to tell people at dinner parties, and the pedals were extra! They had another pair of pedals for $350, but I thought, That’s just ridiculous! It never fails to get a chuckle out of the old guys, the best of whom are already in terrible shape: Creaking hips and murmuring hearts. Hair gone gray or just gone. Teeth yellow from a half century of coffee. Nostrils brimming with coarse hairs. Dr. Von Hatter grits his teeth, breathes deeper, tries to keep his speedometer above ten as he goes up and up and up.
People. All around the park, he buzzes by them: Young and old, fat and thin, boy and girl. Women drinking coffee. Children sledding, cutting great muddy swaths deep into the white landscape. Some geek with snowshoes on. Grown men building an obscene snow woman. Girls with apple-red cheeks catching snowflakes on crimson tongues. The doctor sees blurry coronas of light around them as he speeds by, like a comet passing loafing stars.
He pedals up the East Drive, past a yellow truck selling Belgian waffles and hot chocolate, the sweet scent of which follows him around the partly frozen disk of the reservoir, within sight of the solemn cement twist of the Guggenheim. He rides down into a long valley, reaching a top speed of thirty-eight miles per hour, and his sixty-year-old heart sings. He loves the valleys more than he hates the hills, and he supposes this is what it means to be happy. Uphill or down, the hours he spends on the bike are the happiest of his week — though he can’t admit that to Alice, or to Sasha at the office. He has to pretend not to be thinking about cycling as he studies the slides she’s prepared. She had a whole pile ready for him this morning when he came in, still reeling from his morning ride. De-pressing! he says to himself as he coasts down a small hill. Once, he felt a certain joy in seeing the clean samples — knowing these were lives extended, right there in front of him. But these days he only takes note of the young patients, the cases beyond help, the disturbing mutations.
Today he left the lab for lunch after just a few hours, thinking only of his proximity to cell towers, of the air quality, of broken microwaves emitting radiation, of preservatives even in his supposedly organic food. Sasha was now sending out the reports for the day’s samples: little verdicts transmitted in ones and zeros through the ether to his colleagues citywide. He took off before she even opened the first report. Because standing still is dying — of that much he is sure. Standing still is waiting for the end. But when up on his bicycle, flying across the pavement, he feels untouchable: Faster than the UV rays that the stratosphere doesn’t block. Stronger than the heavy metals in his drinking water. Younger than he was in his youth.
He knows Death, knows His smell and His chill and His last gasping. Many times they have seen each other. He will never stop for Death. If Death wants him, He’ll have to come fast or take him in his sleep. B Group, here I come, he thinks as he huffs past the baseball diamonds, their lines and bases and mounds lost under the snow. He puffs past Mount Sinai, the hospital where he spent more hours of his life than he has in any apartment. He looks up at the wide white sky, and for a second he thinks he sees a red hot-air balloon way off over the Bronx. But it is just a child’s mylar balloon, right there in the park — helium filled, nonbiodegradable, soon to be choked on by dolphins out in the churning black Atlantic. Halfway around, he thinks. Just one last lap.
In her office at Mount Sinai Hospital, Dr. Zarrani leafs through a report that was sent over from Park Avenue Pathology a few hours earlier. Another jagged, illegible signature: “Dr. Von Hatter.” It’s no stereotype that doctors have bad handwriting. She believes it stems from an innate unwillingness to take responsibility for anything, each stormy jot a last-ditch defense against a malpractice suit — as if, in a courtroom somewhere, some panel of experts might someday study the signature and conclude that they can’t definitively say it belongs to the accused doctor. Beneath Von Hatter’s scrawl is the loopy script of the histotechnician, Sasha Trzynski: carefree and cloud fluffy, not important enough to ever get in serious trouble. Lifting a pen to the opposing line, Dr. Zarrani adds her own stark signature, a sort of italicized printing in all capitals: DR. ATOOSA ZARRANI.
She takes the file with her down the hallway and into a little room with all the furniture bolted down, where Irene Richmond has been waiting for fifteen minutes. Irene turns out to be a young blond woman reading an old paperback. At her feet are several bags filled with, Dr. Zarrani guesses, Christmas gifts. She smells faintly like a pet shop. It’s lucky she was able to come in so quickly after they called.
They shake hands. Dr. Zarrani pretends to study the file another moment, though actually she is glancing discreetly at the young woman, who has eyes the black-blue of the ocean and keeps one finger in the book of fairy tales to save her place. She is alone. Usually people bring a friend, a family member, somebody.
“You came by yourself?”
The girl — it is hard not to think of her as a girl — looks around as if to check and, finding no one, shrugs.
“Usually people bring a friend or a family member.” Fearing the girl is becoming uncomfortable, Dr. Zarrani laughs stiffly. “This morning a woman brought her doorman — a little Hungarian gentleman with red epaulets and a hat.”
This makes them both smile. Once that is done, Dr. Zarrani clears her throat.
“Ms. Richmond, you have cancer.”
The young woman looks down quietly as she digests this news. She sets the book on the table, leaving it open, and reaches to adjust the sleeve of her dress.
“Well, shit,” she says finally.
Dr. Zarrani continues in her practiced, even tone, explaining to Ms. Richmond that she has a malignant osteosarcoma in the bone of her left eye socket. Dr. Zarrani watches as the patient slowly absorbs this information. She prefers the ones who don’t cry — not because there is anything wrong with crying at this kind of news, and not because it makes the conversation easier for her (though it does), but because it is a sign of how things tend to go. Crying wastes time, and people who waste time, who wallow, are less prepared, less capable. It’s that simple. In 1978, when supporters of the Ayatollah killed Dr. Zarrani’s father and her older brother, she didn’t cry. Instead she grabbed her little brother, Mehdi, by the wrist and pulled him down into a ditch behind the house, where they lay in the mud until the coast was clear. Those who do not cry survive more often. This she believes.
But even as they discuss things further, getting into the usual questions like causes (none known) and survival rates (around 68 percent), this girl — this young woman — remains eerily calm. Dr. Zarrani gives her a recommendation of chemotherapy followed by radiation, which doesn’t go over well. The girl is a painter and more worried about losing her vision as a side effect of treatment than she is about staying alive, which is frustrating, though pretty typical with younger patients — actually, with patients of any age, which is why it can be helpful to have someone else there to provide perspective. In any event, the girl says it is nonnegotiable, and Dr. Zarrani resists the urge to remind her that having cancer is not a negotiation. They make small talk. The doctor wants to give her time to absorb the news. Eventually Dr. Zarrani ventures to ask why no one came with her.
Irene laughs and says, “Don’t worry. I can handle this on my own.”
Dr. Zarrani just shakes her head. “I’m sorry, Ms. Richmond, but I’ve seen Navy SEALs who couldn’t handle this on their own. You’re going to have to have some help. You’ll need people to get you to treatments and take you back home again. You’re going to feel sick all the time. Someone’s got to make you eat, because you won’t want to. You’re going to need prescriptions filled and insurance claims filed. Listen to me when I say this: You are about to go to war with your own body. That’s the best way to describe it.”
For the first time Irene Richmond looks genuinely scared.
“If you don’t have friends you can trust with something like this, we can arrange—”
“No, it’s not that. It’s . . . you know, my friends are great. . . .”
Dr. Zarrani is silent a moment. And then she understands.
“Ms. Richmond, you can’t protect them from this. I’m sorry.”
And this is when the girl begins to cry.
Dr. Zarrani reaches across the table and takes her hand. She wants to tell her how she pried open barbed-wire fences and stole pomegranates from guarded compounds just to feed her brother, while she went to sleep hungry. She wants to tell this girl how, after all that, they arrived at a boat heading for Italy, the lone survivors of the Zarrani family — but at least they survived. Then, two days after arriving in Rome, her brother came down with malaria. A thirsty mosquito had bitten Mehdi’s neck during their escape, drunk his blood, and paid for the meal with a single parasitic cell, a Plasmodium malariae protist. One single cell. She hadn’t understood that then, of course — on some level she hardly understood it now. She has seen the photos in medical books, taken with high-powered microscopes, of a little oblong creature, stained blue and purple on the slides, but it still makes no sense to her: That it, too, lives. That its only function is to feast upon blood cells, to survive, to multiply. That, in doing so, this thing kills the body it lives in — a universe so vast it can’t ever know its borders — and so finally kills itself. What is the point?
Mehdi made it onto the boat bound for America. She’d hidden his vomiting, headaches, and fevers from authorities. But halfway across the ocean, his list of symptoms grew to include convulsions and partial blindness. The sailors forced them both to stay in quarantine. When Mehdi finally died, they tossed his body overboard — unsure what he had and not wanting anyone else to get sick. Grief-stricken, she jumped into the water after his blue body, but one of the sailors pulled her back out.
She remained in quarantine the rest of the journey, just in case. She arrived in America with nothing and went to stay with friends of a third cousin on Staten Island. They raised her like their own child. They put her in school. She learned English; she learned biology; she went to Westchester Community College; she went to City University; she went to Albert Einstein College of Medicine. Then she came to do her residency at Mount Sinai and never left.
Here she is. Watching Irene Richmond weep and holding her hand. She does this almost every single day. She pulls them from the shock of the cold water. With her touch she tries to express to them what she eventually came to understand after the sailor rescued her from the water: that just because it is all so very, very unfair does not mean there is not still great hope in the world.